BTTTT 08 2016 TT BTTTT 30032016

B THNGTIN V TRUYN THNG
CNG HA X HI CH NGHA VIT NAM
c lp - T do - Hnh phc
H Ni, ngy 30 thng 3 nm 2016
S: 08/2016/TT-BTTTT
THNG T
Hng dn thc hin Chng trnh
cung cp dch v vin thng cng ch n nm 2020
Cn c Lut Vin thng ngy 23/11/2009;
Cn c Ngh nh s 25/2011/N-CP ngy 06/4/2011 ca Chnh ph quy
nh chi tit v hng dn thi hnh mt s iu ca Lut Vin thng;
Cn c Ngh nh s 132/2013/N-CP ngy 16/10/2013 ca Chnh ph
quy nh chc nng, nhim v, quyn hn v c cu t chc ca B Thng tin
v Truyn thng;
Cn c Quyt nh s 11/2014/Q-TTg ngy 27/01/2014 ca Th tng
Chnh ph v t chc v hot ng ca Qu Dch v vin thng cng ch Vit
Nam;
Cn c Quyt nh s 1168/Q-TTg ngy 24/7/2015 ca Th tng
Chnh ph ph duyt Chng trnh cung cp dch v vin thng cng ch n
nm 2020;
Theo ngh ca V trng V Qun l doanh nghip,
B trng B Thng tin v Truyn thng ban hnh Thng t Hng dn
thc hin Chng trnh cung cp dch v vin thng cng ch n nm 2020.
Chng I
QUY NH CHUNG
iu 1. Phm vi iu chnh
Thng t ny hng dn t chc thc hin Chng trnh cung cp dch v
vin thng cng ch n nm 2020 c ph duyt ti Quyt nh s 1168/QTTg ngy 24/7/2015 ca Th tng Chnh ph (sau y gi tt l Chng trnh).
iu 2. i tng p dng
1. C quan, t chc, doanh nghip vin thng tham gia thc hin Chng
trnh;
1
2. i tng c th hng ca Chng trnh.

Chng II
QUY NH C TH
Mc 1
H TR THIT LP H TNG VIN THNG
iu 3. Cc nhim v v ni dung h tr thit lp h tng vin thng
Cc nhim v v ni dung h tr thit lp h tng vin thng bao gm:
1. H tr u t xy dng mng cp quang ti a 24 si thit lp h
thng truyn dn bng rng n cc x cha c kt ni truyn dn bng rng;
2. H tr u t xy dng mng cp quang ti a 64 si, ti a 5 tuyn
cp thit lp mng truy nhp bng rng c nh ti mi x cha c mng truy
nhp bng rng c nh;
3. H tr u t xy dng ti mi x min ni, hi o ti a 03 trm v
mi x ng bng ti a 02 trm thu pht sng thng tin di ng 3G thit lp
mng truy nhp bng rng di ng ti cc x cha c mng truy nhp bng rng
di ng;
4. H tr u t 03 my tnh, 03 b lu in, 01 my in hoc my scan,
01 b chuyn mch LAN, bn gh v cc lp t ban u ti mi im thit
lp 500 im cung cp dch v truy nhp Internet cng cng ti cc x c t l
h gia nh l thu bao s dng dch v truy nhp Internet bng rng c nh
thp v cha c im truy nhp Internet cng cng.
iu 4. Lp Danh mc d n u t thit lp h tng vin thng
1. Cn c hng dn ca B Thng tin v Truyn thng v Mu 01/HT
Ph lc ban hnh theo Thng t ny:
a) y ban nhn dn cp tnh ch tr, phi hp vi doanh nghip vin
thng lp Danh mc, s b Tng mc u t v thuyt minh cc d n ti a
phng thc hin cc nhim v ti cc Khon 1, 2, 3 iu 3 Thng t ny;
b) Doanh nghip vin thng lp Danh mc, s b Tng mc u t v
thuyt minh cc d n thc hin nhim v ti Khon 4 iu 3 Thng t ny.
2. Trn c s Danh mc, s b Tng mc u t v thuyt minh cc d n
ca y ban nhn dn cp tnh v doanh nghip xut, Ban Qun l Chng
trnh cung cp dch v vin thng cng ch (sau y gi tt l Ban Qun l
Chng trnh) tng hp v xc nh cc d n theo cc tiu ch ch yu sau y:
a) Ph hp vi cc quy hoch, k hoch pht trin ca ngnh, a phng,

doanh nghip vin thng;
b) Quy m d n ph hp vi tin trin khai v kinh ph Chng trnh;
c) c im v iu kin a phng;
d) V tr a l ca cc a im cn trin khai nhim v;
) Thc trng h tng mng vin thng;
e) c lp trong t chc thc hin d n v qun l, vn hnh, khai thc
sau u t.
3. Ban Qun l Chng trnh trnh B Thng tin v Truyn thng ph
duyt Danh mc v s b Tng mc u t cc d n cho ton b Chng trnh.
iu 5. Lp k hoch u t
Cn c Danh mc v s b Tng mc u t cc d n c ph duyt,
kinh ph thc hin Chng trnh, Ban Qun l Chng trnh trnh B Thng tin
v Truyn thng ph duyt K hoch u t cc d n v mc vn cc d n nh
sau:
1. Nm 2016, ph duyt K hoch u t cc d n khi cng trong giai
on t nm 2016 n nm 2018.
2. Nm 2018 ph duyt K hoch u t cc d n khi cng trong nm
2019 v nm 2020.
iu 6. La chn Ch u t
1. Tiu ch v iu kin la chn Ch u t:
a) Kinh ph xut h tr v Tng mc u t ca d n;
b) D kin thi gian thc hin d n;
c) Yu cu v cng ngh, k thut, tiu chun, cht lng cng trnh d n;
d) T trng h tng mng vin thng ti a phng;
) Kinh ph h tr mt doanh nghip thit lp h tng vin thng trong
ton b Chng trnh khng vt qu 70% tng kinh ph dnh cho u t thit lp
h tng vin thng ca Chng trnh.
2. Cn c K hoch u t c ph duyt, Ban Qun l Chng trnh
lp v gi H s mi ng k tham gia n doanh nghip theo Mu 02/HT Ph lc
ban hnh km theo Thng t ny.
3. Doanh nghip gi Ban Qun l Chng trnh H s ng k tham gia
theo Mu 03/HT Ph lc ban hnh km theo Thng t ny.

4. Cn c cc tiu ch la chn Ch u t v H s ng k tham gia,
Ban Qun l Chng trnh trnh B Thng tin v Truyn thng ph duyt Ch
u t i vi tng d n.
5. Trng hp ch c duy nht mt doanh nghip tham gia v p ng yu
cu ca H s ng k tham gia, B Thng tin v Truyn thng ch nh doanh
nghip lm Ch u t thc hin d n.
6. Trong trng hp khng la chn c doanh nghip theo Khon 4, 5
iu ny, B Thng tin v Truyn thng giao mt doanh nghip lm Ch u t
da trn mt s tiu ch ch yu: Nng lc mng li v ti chnh ca doanh
nghip, thc trng h tng vin thng ti a phng.
iu 7. T chc thc hin, qun l d n
1. Ch u t lp d n v trnh B Thng tin v Truyn thng ph duyt.
2. Ch u t thc hin v qun l d n u t theo quy nh ca php
lut v u t, u thu, xy dng v cc quy nh khc ca php lut c lin
quan.
3. Tm ng, thanh ton, quyt ton
a) Vic tm ng, thanh ton, quyt ton theo cc quy nh ca php lut;
b) Qu dch v vin thng cng ch Vit Nam hoc n v c y thc
vic cp pht kinh ph ca Chng trnh thc hin tm ng v thanh ton kinh
ph h tr theo quy nh ca php lut v quy nh v qun l ti chnh ca Qu.
4. Ch u t thc hin tip nhn ti sn, qun l ti sn theo cc quy
nh ca php lut.
5. Hng nm, doanh nghip (Ch u t) xy dng k hoch sa cha
ln/nng cp ti sn nu ti Khon 4 iu ny gi B Thng tin v Truyn
thng xem xt, b tr kinh ph t Chng trnh thc hin theo quy nh.
Mc 2
H TR CUNG CP DCH V VIN THNG CNG CH
iu 8. Dch v vin thng cng ch
1. Dch v vin thng cng ch bt buc bao gm:
a) Dch v vin thng cng ch khn cp (dch v gi n cc s dch v
khn cp, bao gm s dch v gi Cng an 113, s dch v gi Cu ha 114, s
dch v gi Cp cu y t 115);
b) Dch v vin thng cng ch di ng hng hi phc v hot ng tm

kim, cu nn trn bin qua h thng i thng tin duyn hi;
c) Dch v vin thng cng ch v tinh phc v hot ng ch o, iu
hnh phng, chng thin tai.
2. Dch v vin thng cng ch ph cp bao gm:
a) Dch v vin thng cng ch tr gip tra cu s thu bao in thoi c
nh (dch v gi n s tr gip tra cu s thu bao in thoi mng vin thng
c nh mt t 116);
b) Dch v vin thng cng ch in thoi c nh mt t tr sau;
c) Dch v vin thng cng ch thng tin di ng mt t tr sau;
d) Dch v vin thng cng ch di ng hng hi cho tu, thuyn nh bt
hi sn trn bin qua h thng i thng tin duyn hi;
) Dch v vin thng cng ch truy nhp Internet bng rng c nh tr
sau;
e) Dch v vin thng cng ch knh thu ring c nh mt t;
g) Dch v vin thng cng ch truyn dn tn hiu truyn hnh s qua v
tinh VINASAT;
h) Dch v vin thng cng ch thu knh truyn dn cp quang trn c s
h tng cp quang ca Tp on in lc Vit Nam.
iu 9. i tng th hng
1. i tng c hng gi cc dch v vin thng cng ch:
a) Ngi s dng dch v in thoi c nh mt t ni ht gi n cc
s dch v khn cp trong phm vi ni ht;
b) Ng dn Vit Nam trn tu, thuyn nh bt hi sn trn bin s dng
dch v vin thng cng ch di ng hng hi qua h thng i thng tin duyn
hi phc v hot ng trong cc s kin tm kim, cu nn trn bin;
c) Thnh vin thuc Ban Ch o Trung ng v phng chng thin tai s
dng dch v vin thng cng ch v tinh phc v hot ng ch o, iu hnh,
phng, chng thin tai;
d) Ngi s dng dch v vin thng cng ch in thoi c nh mt t
ni ht gi n s dch v tr gip tra cu s thu bao in thoi c nh mt
t;
) H ngho hoc h cn ngho theo quy nh chun ngho quc gia,
5
chun cn ngho quc gia s dng dch v vin thng cng ch in thoi c
nh mt t tr sau hoc dch v thng tin di ng mt t tr sau;
e) Ng dn Vit Nam trn tu, thuyn nh bt hi sn trn bin s dng
dch v vin thng cng ch di ng hng hi qua h thng i thng tin duyn
hi;
g) Trng hc, bnh vin, y ban nhn dn cp x theo quy nh s dng
dch v vin thng cng ch truy nhp Internet bng rng c nh mt t tr
sau;
h) Bnh vin v tinh, bnh vin ht nhn trong n bnh vin v tinh
giai on 2013-2020 theo Quyt nh s 774/Q-BYT ngy 11/3/2013 ca B
trng B Y t s dng dch v vin thng cng ch knh thu ring c nh mt
t tc 2Mbps c d phng kt ni bnh vin v tinh vi bnh vin ht
nhn ca nhm;
i) i pht thanh, truyn hnh cp tnh cha t ch v ti chnh s dng
dch v vin thng cng ch truyn dn qung b cho mt knh chng trnh
truyn hnh a phng s dng bng tn Ku ca v tinh VINASAT pht
chng trnh truyn hnh phc v nhim v chnh tr, thng tin tuyn truyn
thit yu ca a phng cho cc khu vc min ni, bin gii, hi o, cc vng
lm kh thu c tn hiu truyn hnh s mt t.
2. i tng c hng mc h tr cung cp dch v vin thng cng
ch:
a) Doanh nghip vin thng cung cp dch v cho cc i tng th hng
nu ti Khon 1 iu ny;
b) Doanh nghip vin thng cung cp dch v truy nhp Internet cng cng
thuc phm vi Chng trnh cung cp dch v vin thng cng ch n nm
2020 theo Quyt nh s 1168/Q-TTg ngy 24/7/2015 ca Th tng Chnh
ph;
c) Doanh nghip vin thng thu si cp quang ca n v thuc Tp on
in lc Vit Nam kt ni t t lin ti trung tm hnh chnh ca cc huyn
o Ct Hi, C T, L Sn, Ph Quc, Vn n.
iu 10. Nguyn tc h tr
1. Danh mc, i tng th hng, phm vi, gi cc s dng, mc v
thi im h tr thc hin theo quy nh ca B Thng tin v Truyn thng v
danh mc, i tng th hng, phm vi, cht lng, gi cc, khung gi cc
s dng v mc h tr cung cp dch v vin thng cng ch n nm 2020.
2. i tng th hng quy nh ti cc im a, b, c, d Khon 1 iu 9

Thng t ny khng phi lp danh sch i tng th hng.
3. i tng th hng quy nh ti cc im , e, g, h, i Khon 1 iu 9
v cc im truy nhp Internet cng cng nu ti im b Khon 2 iu 9 Thng
t ny c lp thnh danh sch i tng th hng v danh sch ny c S
Thng tin v Truyn thng xc nhn.
a) i tng pht sinh trong qu ngoi danh sch i tng th hng
c xc nhn, doanh nghip tng hp, bo co S Thng tin v Truyn thng
xc nhn h tr i tng t qu tip theo;
b) i tng th hng trong danh sch i tng th hng ng k
ngng h tr, doanh nghip tng hp, bo co S Thng tin v Truyn thng v
ngng h tr cho i tng.
c) Kinh ph h tr cho S Thng tin v Truyn thng thc hin vic xc
nhn i tng th hng thc hin theo quy nh ca B Ti chnh.
4. Cc i tng th hng c h tr kinh ph trn thc t, khng ph
thuc k hoch cung cp v d ton kinh ph h tr dch v vin thng cng ch
hng nm (sau y gi tt l K hoch v D ton kinh ph).
iu 11. Lp v xc nhn danh sch i tng th hng
1. ng k h tr
a) i tng th hng quy nh ti cc im , g, h, i Khon 1 iu 9
Thng t ny thc hin ng k h tr vi doanh nghip vin thng hoc n v
thnh vin, n v trc thuc ca doanh nghip vin thng theo cc Ph biu ti
Mu 01/DV Ph lc ban hnh km theo Thng t ny;
b) i tng th hng quy nh ti im e Khon 1, im b Khon 2
iu 9 Thng t ny khng phi ng k h tr, doanh nghip lp v gi S
Thng tin v Truyn thng danh sch i tng th hng theo cc Ph biu ti
Mu 02/DV Ph lc ban hnh km theo Thng t ny.
2. Lp danh sch i tng th hng ng k h tr
a) Doanh nghip vin thng lp v gi v S Thng tin v Truyn thng
danh sch i tng th hng ng k h tr theo cc Ph biu ti Mu 02/DV
Ph lc ban hnh km theo Thng t ny;
b) Doanh nghip vin thng la chn ch mt thu bao hoc mt gi cc
hoc mt knh thu ring hoc mt knh chng trnh c ng k sau cng
cho mt i tng th hng khi i tng th hng ng k h tr nhiu hn
mt thu bao hoc mt gi cc hoc mt knh thu ring hoc mt knh
7
chng trnh truyn hnh.

3. Xc nhn danh sch i tng th hng
a) S Thng tin v Truyn thng kim tra v xc nhn cc danh sch i
tng th hng, m bo ng i tng h tr theo quy nh ca B Thng
tin v Truyn thng v danh mc, i tng th hng, phm vi, gi cc s
dng v mc h tr cung cp dch v vin thng cng ch n nm 2020;
b) Trng hp i tng th hng ng k h tr vi nhiu doanh
nghip, S Thng tin v Truyn thng xc nh doanh nghip c ng k sau
cng l doanh nghip h tr cho i tng ;
c) S Thng tin v Truyn thng gi doanh nghip v Ban Qun l
Chng trnh danh sch i tng th hng c xc nhn theo cc Ph
biu ti Mu 02/DV Ph lc ban hnh km theo Thng t ny.
4. Cp nht i tng pht sinh
a) Hng qu, doanh nghip lp danh sch i tng th hng pht sinh
trong qu v gi S Thng tin v Truyn thng trc ngy th 15 ca qu tip
theo;
b) Trong thi hn 10 ngy k t ngy nhn c danh sch i tng pht
sinh, S Thng tin v Truyn thng xc nhn, gi doanh nghip v Ban Qun l
Chng trnh danh sch ny.
iu 12. Lp K hoch v D ton kinh ph hng nm
1. Trc ngy 30 thng 9 hng nm, cn c hng dn ca B Thng tin
v Truyn thng, danh sch i tng th hng c xc nhn v tnh hnh
cung cp dch v vin thng cng ch nm thc hin, doanh nghip lp K hoch
v D ton kinh ph gi Ban Qun l Chng trnh theo cc Ph biu ti Mu
03/DV Ph lc ban hnh km theo Thng t ny.
2. Trc ngy 31 thng 10 hng nm, Ban Qun l Chng trnh trnh B
Thng tin v Truyn thng ph duyt K hoch v D ton kinh ph ca cc
doanh nghip.
3. i vi nm 2016, doanh nghip lp K hoch v D ton kinh ph sau
thi im Thng t ny c ban hnh.
iu 13. Hp ng t hng
1. Trc ngy 01 thng 01 hng nm, cn c K hoch v D ton kinh ph
c ph duyt, Ban Qun l Chng trnh v doanh nghip thng tho, k kt
hp ng t hng cung cp dch v vin thng cng ch (sau y gi tt l Hp
ng) theo Mu 04/DV Ph lc ban hnh km theo Thng t ny.

2. Doanh nghip thc hin cung cp dch v vin thng cng ch theo ni
dung Hp ng k kt.
iu 14. Nghim thu, quyt ton v thanh l hp ng t hng
1. Trong thi gian 20 ngy u mi qu, doanh nghip lp Bo co thc
hin cung cp dch v vin thng cng ch qu trc theo cc Ph biu ti Mu
05/DV Ph lc ban hnh km theo Thng t ny v gi Ban Qun l Chng
trnh.
2. Trong thi gian 30 ngy k t khi nhn c Bo co thc hin cung
cp dch v vin thng cng ch qu trc, Ban Qun l Chng trnh t chc
lp bin bn xc nh sn lng v kinh ph h tr theo cc Ph biu ti Mu
06/DV Ph lc ban hnh km theo Thng t ny v gi Qu Dch v vin thng
cng ch Vit Nam hoc n v c y thc vic cp pht kinh ph ca Chng
trnh thc hin tm ng, thanh ton kinh ph h tr.
3. Trc ngy 31 thng 3 hng nm, Ban Qun l Chng trnh v doanh
nghip t chc v lp bin bn nghim thu v bin bn thanh l Hp ng nm
trc theo cc Ph biu ti Mu 07/DV Ph lc ban hnh km theo Thng t
ny.
4. Vic quyt ton kinh ph h tr theo cc quy nh ca php lut.
Mc 3
THC HIN H TR U THU TRUYN HNH S
iu 15. i tng, iu kin, phng thc, ni dung, vng v thi
gian thc hin h tr
1. i tng h tr: Cc h ngho v h cn ngho theo tiu chun
ngho, cn ngho quc gia c cp c thm quyn ph duyt ti thi im thc
hin h tr u thu truyn hnh s v thuc vng h tr.
2. iu kin nhn h tr
a) H ngho, h cn ngho ang s dng my thu hnh cng ngh tng
t cha tch hp tnh nng thu truyn hnh s theo chun DVB-T2, cha c u
thu truyn hnh s DVB-T2, cha s dng bt k mt trong cc phng thc
truyn hnh tr tin nh truyn hnh cp, truyn hnh v tinh, truyn hnh
Internet (IPTV) trong thi gian trin khai h tr ti a phng;
b) n ngh nhn h tr u thu truyn hnh s c xc nhn l h
ngho, h cn ngho ca x, phng, th trn theo Mu 01/THS Ph lc ban
hnh km theo Thng t ny.
9
3. Phng thc v ni dung h tr

Mi h ngho, h cn ngho c nhn mt ln gm 01 u thu truyn
hnh s mt t hoc v tinh km theo ng-ten thu ph hp cng vi dy cp ni
c di ti a 15 mt (i vi ch thu ngoi tri), c lp t hon chnh
v bo hnh t nht 12 thng tnh t ngy h gia nh nhn bn giao u thu
truyn hnh s.
4. Vng h tr
Vng h tr l vng m cc h dn thu tn hiu truyn hnh b nh
hng khi cc i truyn hnh ngng pht sng truyn hnh tng t mt t
chuyn sang pht sng truyn hnh s mt t hoc v tinh theo tng giai on
do B Thng tin v Truyn thng cng b.
5. Thi gian thc hin h tr
Thi gian thc hin h tr theo l trnh ca n s ha truyn dn, pht
sng truyn hnh mt t n nm 2020 c quy nh ti Quyt nh s
2451/Q-TTg ngy 27/12/2011 ca Th tng Chnh ph v k hoch thc hin
ca Ban Ch o n s ha truyn hnh Vit Nam theo tng giai on.
iu 16. Lp k hoch v d ton kinh ph h tr
1. Trc ngy 30 thng 9 hng nm, cn c Hng dn ca B Thng tin
v Truyn thng, y ban nhn dn cp tnh lp v gi v B Thng tin v
Truyn thng K hoch v d ton kinh ph h tr u thu truyn hnh s theo
Mu 02/THS, 03/THS, 04/THS, 05/THS Ph lc ban hnh km theo Thng t
ny.
2. Trc ngy 31 thng 10 hng nm, Ban Qun l Chng trnh tng
hp, trnh B Thng tin v Truyn thng ph duyt K hoch v d ton kinh
ph h tr u thu truyn hnh s.
iu 17. T chc thc hin d n mua sm, lp t u thu truyn
hnh s
1. Trn c s K hoch v d ton kinh ph h tr u thu truyn hnh s
c ph duyt, B Thng tin v Truyn thng la chn n v trc thuc B
lm ch u t thc hin v qun l d n mua sm u thu truyn hnh s.
2. n v c chn lm ch u t xy dng, trnh B Thng tin v
Truyn thng ph duyt d n, t chc u thu mua sm u thu truyn hnh s
theo quy nh ca php lut v u t, u thu sau khi d n c ph duyt v
quyt ton d n u t theo quy nh.
3. y ban nhn dn cp tnh ch o, t chc v phi hp vi ch u t,
10
nh thu phn phi u thu truyn hnh s ng, kp thi v trc tip cho cc i
tng c th hng theo quy nh.
4. y ban nhn dn cp tnh t chc thc hin xc nhn danh sch i
tng nhn u thu truyn hnh s ti a phng theo Mu 06/THS, 07/THS
Ph lc ban hnh km theo Thng t ny.
5. Qu dch v vin thng cng ch Vit Nam hoc n v c y thc
vic cp pht kinh ph ca Chng trnh thc hin tm ng, thanh ton y ,
kp thi kinh ph h tr u thu truyn hnh s theo cc quy nh ca php lut
v quy nh v qun l ti chnh ca Qu.
6. Kinh ph t chc, trin khai, kim tra, gim st v xc nhn h tr u
thu truyn hnh s thuc nhim v ca a phng c trch t ngun ngn
sch a phng v cc ngun hp php khc.
7. Cn c kh nng ngn sch a phng v cc ngun hp php khc,
y ban nhn dn cp tnh quyt nh h tr u thu truyn hnh s mt t i
vi h ngho, h cn ngho theo tiu chun h ngho, cn ngho ca a
phng v cc i tng chnh sch x hi.
Mc 4
THC HIN CC NHIM V KHC
iu 18. Cc nhim v khc
1. H tr trin khai cc gii php tng cng bo m lin lc an ton, tin
cy trong vic thit lp mng v cung cp dch v vin thng cho cng ng v
cho ch o iu hnh ca chnh quyn cc cp.
2. H tr thit lp cng thng tin in t ca y ban nhn dn cc cp v
dch v cng trc tuyn trn cng phc v ngi dn, tp trung cho vng su,
vng xa, vng kh khn, vng bin gii, hi o.
3. H tr u t trang b my pht truyn hnh s mt t pht cc knh
chng trnh phc v nhim v chnh tr, thng tin tuyn truyn thit yu ti
vng su, vng xa, vng kh khn, vng bin gii, hi o.
4. H tr thit lp cng thng tin in t v tng i h tr, t vn gii
p thng tin v s ha truyn hnh.
5. H tr kinh ph thc hin iu tra phng thc thu xem v tuyn truyn
v s ha truyn dn, pht sng truyn hnh mt t n nm 2020.
iu 19.Trnh t thc hin
1. B Thng tin v Truyn thng hng dn lp, ph duyt K hoch v
d ton kinh ph h tr thc hin cc nhim v.
11
2. n v c la chn, giao thc hin nhim v thc hin theo quy nh

ca php lut.
Chng III
KIM TRA, GIM ST, BO CO V T CHC THC HIN
iu 20. Kim tra, gim st v bo co
1. Kim tra, gim st
a) Hng nm, Ban Qun l Chng trnh lp k hoch, ni dung kim tra
nh k, t xut, trnh B Thng tin v Truyn thng ph duyt; phi hp vi
cc B, y ban nhn dn cp tnh, doanh nghip v cc n v lin quan ca B
Thng tin v Truyn thng t chc vic kim tra thc hin cc d n, hp ng.
b) Hng nm, y ban nhn dn cc tnh, thnh ph trc thuc Trung ng
ch o t chc, phi hp kim tra nh k, t xut theo k hoch kim tra ca
B Thng tin v Truyn thng hoc theo yu cu qun l ca a phng.
c) S Thng tin v Truyn thng ch tr xut k hoch, ni dung kim
tra, gip y ban nhn dn tnh ch o cc S, ban, ngnh, n v lin quan t
chc hoc phi hp kim tra nh k, t xut cc d n, hp ng.
d) Cc t chc, doanh nghip tham gia Chng trnh t chc v phi hp
kim tra nh k, t xut v gim st thng xuyn cc ni dung trin khai ca
Chng trnh theo quy nh hin hnh.
2. Bo co
a) y ban nhn dn cp tnh, thnh ph trc thuc Trung ng quy nh
ch bo co thc hin Chng trnh trn a bn.
b) S Thng tin v Truyn thng, Qu Dch v vin thng cng ch Vit
Nam, Ban qun l Chng trnh, cc t chc, doanh nghip tham gia Chng
trnh thc hin bo co nh k v t xut theo quy nh.
c) Cc biu mu bo co nh k c quy nh ti Mu 01/BC, 02/BC,
03/BC Ph lc ban hnh km theo Thng t ny. Cc bo co t xut c B
Thng tin v Truyn thng hng dn trong qu trnh thc hin trin khai
Chng trnh.
d) Cc t chc, doanh nghip tham gia Chng trnh thc hin bo co
nh k theo cc mu biu quy nh ti im c Khon 2 iu 20 Thng t ny
v cc bo co t xut do B Thng tin v Truyn thng hng dn trong qu
trnh thc hin.
3. B Thng tin v Truyn thng thc hin s kt, tng kt Chng trnh,
12
bo co Th tng Chnh ph v cc B, Ngnh lin quan.

iu 21. T chc thc hin
1. Thng t ny c hiu lc thi hnh k t ngy 15 thng 5 nm 2016.
2. Ch tch U ban nhn dn cc tnh, thnh ph trc thuc Trung ng,
Chnh Vn phng B, Th trng cc c quan c lin quan thuc B, cc c
quan, t chc, doanh nghip c lin quan chu trch nhim thi hnh Thng t
ny.
3. Trong qu trnh thc hin, nu c vng mc, ngh phn nh kp thi
v B Thng tin v Truyn thng nghin cu, gii quyt./.
Ni nhn:
- Th tng,cc Ph Th tng Chnh ph;
- Vn phng Trung ng v cc Ban ca ng;
- Vn phng Quc hi;
- Vn phng Chnh ph;
- Vn phng Ch tch nc;
- Vn phng Tng B th;
- Vin Kim st nhn dn ti cao;
- Ta n nhn dn ti cao;
- Kim ton nh nc;
- Cc B, c quan ngang B, c quan thuc Chnh ph;
- UBND cc tnh, thnh ph trc thuc TW;
- S TT&TT cc tnh, TP trc thuc TW;
- Cc Kim tra vn bn - B T php;
- Cc doanh nghip vin thng;
- Cng bo; Cng thng tin in t CP;
- B TTTT: B trng, cc Th trng, cc n v thuc
B, Cng thng tin in t;
- Lu: VT,QLDN.
13
B TRNG
Nguyn Bc Son
PH LC
BIU MU CHNG TRNH
(Ban hnh km theo Thng t s
/2016/TT-BTTTT ngy
ca B Thng tin v Truyn thng)
St
t
Tn biu mu
H tr thit lp h tng
Ni nhn
Tn sut
Mu 01/HT Danh mc d n v s
UBND cp tnh
b tng mc u t , thuyt minh
phi hp vi
d n trin khai nhim v thit lp
doanh nghip
h tng vin thng
B TTTT
01
ln/giai
on
Mu 02/HT H s mi ng k
B TTTT
tham gia la chn ch u t
Doanh
nghip
Mu 03/HT ng k tham gia la

Doanh nghip
chn ch u t
B TTTT
II
Ni lp
thng nm 2016
01
ln/giai
on
01
ln/giai
on
H tr dch v
i tng th
hng
Doanh
nghip
01 ln
Doanh nghip
S TTTT
01 ln
Doanh nghip
B TTTT
01
ln/nm
B TTTT,
doanh nghip
B TTTT,
doanh
nghip
01
ln/nm
Mu 05/DV Bo co sn lng, Doanh nghip

kinh ph h tr hng qu
B TTTT
01
ln/qu
B TTTT,
Mu 06/DV Bin bn nghim thu
doanh nghip
sn lng, kinh ph h tr hng qu
4
5
6
7
Mu 01/DV n ng k thu bao

Mu 02/DV Danh sch i tng
th hng
Mu 03/DV K hoch sn lng v
d ton kinh ph h tr
Mu 04/DV Mu hp ng t hng
cung cp dch v vin thng cng
ch
B TTTT,
10 Mu 07/DV Bin bn thanh l hp
doanh nghip
ng t hng
II
H tr u thu truyn hnh s
I
11 Mu 01/THS n ngh h tr H ngho, h
u thu truyn hnh s
cn ngho
Mu 02/THS Danh sch tng hp
12 i tng c h tr u thu S TTTT
truyn hnh s
14
B TTTT,
doanh
nghip
B TTTT,
doanh
nghip
01
ln/qu
01
ln/nm
S TTTT
01 ln/d
n
B TTTT
01 ln/d
n
13
14
15
16
17
IV
Mu 03/THS Danh sch h ngho

c hng h tr u thu truyn
hnh s
Mu 04/THS Danh sch h cn
ngho c hng h tr u thu
truyn hnh s
Mu 05/THS K hoch v d ton
kinh ph h tr u thu truyn hnh
s
Mu 06/THS Bng k chi tit i
tng nhn h tr u thu truyn
hnh s
Mu 07/THS Bo co s lng v
kinh ph h tr u thu truyn hnh
s
S TTTT
B TTTT
01 ln/d
n
S TTTT
B TTTT
01 ln/d
n
S TTTT
B TTTT
01 ln/d
n
Doanh nghip
UBND
cp tnh
Ch u t
B TTTT
01 ln/d
n
01 ln/d
n
Bo co
Mu 01/BC Bo co ngun vn
18 hot ng ca Qu dch v vin Qu
thng cng ch Vit Nam
DVVTCIVN
B TTTT
19 Mu 02A/BC Bo co tnh hnh s Ban

dng kinh ph ca Chng trnh
QLCTVTCI
B TTTT
20 Mu 02B/BC Bo co sn lng Ban

c h tr ca Chng trnh
QLCTVTCI
B TTTT
21 Mu 03A/BC Bo co tnh hnh s Doanh nghip

dng kinh ph ca Chng trnh
B TTTT
22 Mu 03B/BC Bo co sn lng Doanh nghip

c h tr ca Chng trnh
B TTTT
15
01
ln/6thn
g
01
ln/6thn
g
01
ln/6thn
g
01
ln/6thn
g
01
ln/6thn
g
Mu 01/HT/Ph biu 01
[H TR THIT LP H THNG TRUYN DN V MNG
TRUY NHP BNG RNG]1)
[H TR TRANG THIT B THIT LP 500 IM TRUY NHP
INTERNET CNG CNG]2)
Chng trnh cung cp dch v vin thng cng ch n nm 2020
[Tn tnh/thnh ph]3)
[Tn doanh nghip khai thc im cung cp dch v truy nhp internet
cng cng]4)
DANH MC D N V S B TNG MC U T
ST
T
1
[Tn d n 1]
2
3
[Tn d n m]
Tn d n
D kin thi gian

thc hin d n
[t thng/nm
n thng /nm]
S b tng mcu
t (VN)
[s b tng mc u
t ca d n] 5)
[t thng/nm
n thng /nm]
[s b tng mc u
t ca d n m]
[s b tng mc u
t cc d n]
Tng
16
Mu 01/HT/Ph biu 02
DANH SCH CC X TRIN KHAI NHIM V THEO MI D N
ST
T
Tn x
M tnh/ tp9)
1
2
n1..
[Tn d n 1] 6)
M huyn9)
M x9)
Tn x
[Tn x A]
[Tn x B]
M tnh/ tp9)
1
2
n2..
..
[Tn d n 2] 6)
M huyn9)
M x9)
Tn x
[Tn x A]
[Tn x B]
Ngy thng nm ..
[TM. Y BAN NHN DN
CH TCH]7)
[I DIN DOANH NGHIP]8)
(K tn ng du)
Ghi ch:
1 ) 3) 7)
S dng trong trng hp lp Danh mc v s b Tng mc u t cc d

n thc hin cc nhim v ti cc Khon 1, 2, 3 iu 3 Thng t ny.
2) 4) 8)
S dng trong trng hp lp Danh mc v s b Tng mc u t cc d

n thc hin nhim v ti Khon 4 iu 3 Thng t ny.
5)
Kinh ph d kin l kinh ph xut h tr t ngun kinh ph Chng trnh.
6)
Mi d n trong Ph biu 02 tng ng vi mt d n lit k ti Ph biu 01.
9)
M tnh/thnh ph, huyn, x c quy nh ti Quyt nh s 124/2004/QTTg ngy 08/7/2004 v vic ban hnh bng danh mc v m s cc n v hnh
chnh Vit Nam.
17
Mu 01/HT/Ph biu 03
NI DUNG C BN THUYT MINH D N [Tn d n ]1)
TNH/TP [tn tnh,tp]2)
1) Nghin cu s cn thit u t, cc iu kin thun li kh khn;
2) Ph hp vi quy hoch, k hoch pht trin ngnh, vng v k hoch
pht trin kinh t - x hi ca a phng;
3) D kin mc tiu, quy m, a im thc hin d n;
4)3) Thuyt minh s b v phng n thit lp h tng vin thng bng
rng v lp cc bng cung cp thng tin theo Mu 01/HT/Ph biu 03/bng 1,
Mu 01/HT/Ph biu 03/bng 2, Mu 01/HT/Ph biu 03/bng 3, Mu
01/HT/Ph biu 03/bng 4, Mu 01/HT/Ph biu 03/bng 5 di y;
5)4) Thuyt minh s b v phng n h tr trang thit b thit lp im
internet cng cng v lp Danh sch trang thit b cn h tr ti cc x thuc d
n theo Mu 01/HT/Ph biu 03/bng 6 di y;
6) Phn tch s b cc yu cu v k thut, tiu chun, cht lng ca
cng trnh d n, sn phm hoc dch v cung cp;
7) D kin thi hn thc hin d n;
8) Phn tch s b phng n ti chnh ca d n: s b tng mc u t
ca d n; d kin vn u t ca Chng trnh tham gia thc hin d n;
9) Nu s b hiu qu u t v kinh t - x hi ca d n;
10) Nhng ni dung cn thit khc (nu c);
Ghi ch:
1)
Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.

Ni dung ny ch dng cho cc d n thc hin cc nhim v ti cc khon
1, 2, 3 iu 3 Thng t ny;
4)
Ni dung ny ch dng cho cc d n thc hin nhim v ti khon 4 iu 3
Thng t ny.
2) 3)
18
Mu 01/HT/Ph biu 03/bng 1

DANH SCH CC X V CC NHIM V CN THC HIN
THIT LP H TNG VIN THNG BNG RNG THUC D N 1)
T
T
Danh sch cc x cn
thit lp h tng vin
thng bng rng
M
M Tn X
huyn x
x n
6)
6)
6)
g
bn
g 2)
(1)
(2) (3)
(4)
[M
[M [T
huyn
n x
A]
x
A]
A]
[M
[M [T
huyn
n x
B]
x
B]
B]
[M
[M [T
huyn
n x
n]
x
n]
n]
Cc nhim v cn thc hin ti

mi x
Ghi
ch
Thit lp Thit lp Thit lp

h thng
mng
mng
truyn truy nhp truy nhp
dn bng bng rng bng rng
rng 3)
c nh 4) di ng 5)
(5)
(6)
(7)
(8)
Ghi ch:
1)
Mi d n ny tng ng vi mt d n lit k ti Ph biu 01;
Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3 iu

3 Thng t ny.
2)
Ct (4) ny ng vi mi x ti ct (3), nu x l x ng bng, in k t x,

ngc li trng.
3)
Ct (5) ny in k t x nu x c tn ti ct (3) c nhim v thit lp h thng

truyn dn bng rng, ngc li trng.
4)
Ct (6) ny in k t x nu x c tn ti ct (3) c nhim v thit lp mng truy

nhp bng rng c nh, ngc li trng.
5)
Ct (7) ny in k t x nu x c tn ti ct (3) c nhim v thit lp mng truy

nhp bng rng di ng, ngc li trng.
19
6)
M tnh/thnh ph, huyn, x c quy nh ti Quyt nh s 124/2004/Q-TTg

ngy 08/7/2004 v vic ban hnh bng danh mc v m s cc n v hnh chnh Vit
Nam.

DANH SCH CC IM KT NI THUC D N 1)
TT
Tn im kt ni
a im im kt ni
M
M Tn
a im
4)
4)
huyn x
x
Ghi ch
4)
I
1
2
n
II
1
2
(1)
(2)
(3)
(4)
(5)
2)
Danh sch cc im kt ni cn thit lp ti x thuc d n
[Tn im kt ni
[M
[M [Tn [a im im
1]
huyn
x]
kt ni 1]
]
x]
[Tn im kt ni
[M
[M [Tn [a im im
2]
huyn
x]
kt ni 2]
]
x]
.
[Tn im kt ni
[M
[M [Tn [a im im
n]
huyn
x]
kt ni n]
]
x]
Danh sch cc im kt ni sn c 3) c la chn cho d n
[Tn im kt ni
[M
[M [Tn [a im im
1]
huyn
x]
kt ni 1]
]
x]
[Tn im kt ni
[M
[M [Tn [a im im
2]
huyn
x]
kt ni 2]
]
x]
.
[Tn im kt ni
[M
[M [Tn [a im im
m]
huyn
x]
kt ni m]
]
x]
Ghi ch:
1)
Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3

iu 3 Thng t ny
2)
im kt ni cn thit lp l im m ti v tr c d tnh t tp trung

cc thit b truyn dn ca x cha c mng truyn dn.
20
3)
im kt ni sn c l im kt cui ca h thng truyn dn bng rng ang

hot ng m ti v tr c th cho php mng truyn dn bng rng cn thit
lp kt ni vo;
im kt ni sn c c la chn cho d n l im kt ni sn c c s
dng trong phng n thit lp h tng vin thng bng rng ca d n.
4)
chnh Vit Nam.
21

DANH SCH CC TUYN KT NI C LA CHN THUC
D N 1)
TT
Tn tuyn kt ni
(1)
Tn
im
kt
ni
u 2)
(2)
Tn
im
kt ni
cui 2)
Chiu di
tuyn (km)
(3)
(4)
Mi
trng
truyn dn
bng rng
Ghi
ch
3)
[Tn tuyn kt ni
c la chn 1]
[Tn
im
kt
ni
u
1]
[Tn
im
kt ni
cui 1]
[chiu di
tuyn kt ni
c la
chn 1]
[Tn tuyn kt ni
c la chn 2]
[Tn
im
kt
ni
u
2]
[Tn
im
kt ni
cui 2]
[chiu di
tuyn kt ni
c la
chn 2]
[Tn tuyn kt ni
c la chn n]
[Tn
im
kt
ni
u
n]
[Tn
im
kt ni
cui n]
[chiu di
tuyn kt ni
c la
chn n]
(5)
Tng chiu di cc
tuyn kt ni ca
h thng truyn
dn thuc d n
[Tng chiu
di cc
tuyn c
la chn]
Ghi ch:
1)

iu 3 Thng t ny.
22
2)
Mi tn im kt ni u hoc cui tng ng vi mt tn im kt ni cn

thit lp hoc tn im kt cui sn c ti ct (1) Mu 01/HT/Ph biu 03/bng
2 trn.
3)
in ct (5) vi cc gi tr quang hoc viba hoc hn hp.
23

DANH SCH CC MNG TRUY NHP BNG RNG C NH
TI CC X THUC D N 1)
TT
Tn mng truy nhp c

nh
Tng chiu di cc
tuyn cp (m)
X ng
bng 2)
(1)
(2)
(3)
Mng truy nhp c nh x

[M huyn, m x, tn x
1] 3)
[Tng chiu di mng

truy nhp ca x 1]
Mng truy nhp c nh x

[M huyn, m x, tn x
2] 3)
[Tng chiu di mng

truy nhp ca x 2]
Mng truy nhp c nh x

[M huyn, m x, tn x
n] 3)
[Tng chiu di mng

truy nhp ca x n]
Tng chiu di cc tuyn

cp ca cc mng truy
nhp ca cc x ng
bng
[Tng chiu di cc
tuyn cp ca cc
mng truy nhp ca
cc x ng bng]
Tng chiu di cc tuyn

cp ca cc mng truy
nhp ca cc x min
ni, hi o
[Tng chiu di cc
tuyn cp ca cc
mng truy nhp ca
cc x min ni, hi
o]
Ghi ch
Ghi ch:
1)

iu 3 Thng t ny.
2)
Ct (3) ny ng vi mi x c tn ti ct (1), nu x l x ng bng in k

t x, ngc li trng.
3)
chnh Vit Nam.
24

DANH SCH CC TRM THU PHT THNG TIN DI NG 3G
THUC D N 1)
TT
1
2
Tn trm thu
a im t trm 3G
pht thng tin di
M
M Tn
a im
ng 3G
huyn x
x
[Tn trm 3G 1]
[M
[M [Tn
[a im
huyn
x]
ca trm 3G
]
x]
1]
[Tn trm 3G 2]
[M
[M [Tn
[a im
huyn
x]
ca trm 3G
]
x]
2]
[Tn trm 3G n]
Tng s trm
thu pht thng
tin di ng 3G
[M
[M [Tn
[a im
huyn
x]
ca trm 3G
]
x]
n]
[Tng s trm thu pht 3G]
Ghi ch
[ta t
trm] (nu c)
[ta t
trm] (nu c)
[ta t
trm] (nu c)
Ghi ch:
1)

iu 3 Thng t ny.
25

DANH SCH TRANG THIT B TI CC X THUC D N 1)
STT
Trang thit b cn h tr
n v S lng
Ghi ch
1 IM ICC TI X [M tnh/tp, m huyn, m x, tn x]
My tnh
b
...
Thit b lu in
b
Switch 5 cng
b
...
My in
ci
Bn gh
b
...
Ph kin tai nghe
b
cc lp t internet
ln
Windows 7
b
B Office 2007
b
...
Phn mm dit Virut
b
2 IM ICC TI X [M tnh/tp, m huyn, m x, tn x]

My tnh
b
..
.
n IM ICC TI X [M tnh/tp, m huyn, m x, tn x]
...
Ghi ch:
1)
Bng ny ch dng cho cc d n thc hin nhim v ti khon 4 iu 3

Thng t ny.
26
Mu 02/HT
H S MI NG K THAM GIA LA CHN CH U T
H S MI NG K THAM GIA LA CHN CH U T

D n: _____________ (ghi tn d n)
H ni, ngy ___thng ___ nm ____

i din hp php ca B Thng tin v Truyn thng
[Ghi tn, chc danh, k tn v ng du]
MC LC
Chng I. Yu cu v th tc mi la chn Ch u t
A. Tng qut
B. Chun b h s ng k tham gia
C. Np h s ng k tham gia
D. Kt qu ng k tham gia
Chng II. Cc thng tin c bn v d n
T NG VIT TT
HSMKTG
H s mi ng k tham gia
HSKTG
H s ng k tham gia
TCG
Tiu chun nh gi h s ng k tham gia

Chng I
27
YU CU V TH TC MI NG K THAM GIA
A. TNG QUT
Mc 1. Ni dung mi ng k tham gia
1. B Thng tin v Truyn thng, 18 Nguyn Du H Ni mi doanh
nghip np HSKTG la chn Ch u t d n _________ [Tn d n hoc
d ton mua sm c duyt].
2. Ni dung cng vic ch yu: _______ [Ghi ni dung yu cu].
3. Ngun vn thc hin d n: Ngun vn ca Chng trnh cung cp
dch v vin thng cng ch n 2020.
Mc 2. HSMKTG v pht hnh HSMKTG
1. HSMKTG bao gm cc ni dung c lit k ti Mc lc ca
HSMKTG ny.
2. B Thng tin v Truyn thng (sau y gi tt l B) pht hnh min
ph HSMKTG cho cc doanh nghip c nhu cu tham gia.
Mc 3. Gii thch lm r HSMKTG
Trng hp doanh nghip mun c gii thch lm r HSMKTG th
phi gi vn bn ngh n B trc thi im ht hn np HSKTG
xem xt, x l (doanh nghip c th thng bo trc cho B qua fax, email...). Sau khi nhn c vn bn yu cu lm r HSMKTG ca doanh
nghip theo thi gian quy nh, B s c vn bn tr li, trong c m t ni
dung yu cu lm r nhng khng nu tn doanh nghip ngh lm r v gi
cho tt c doanh nghip nhn HSMKTG t B. Trng hp vic lm r dn
n phi sa i HSMKTG th B tin hnh sa i HSMKTG theo quy
nh ti Mc 4 Chng ny.
Mc 4. Sa i HSMKTG
Trng hp cn thit, B s tin hnh sa i HSMKTG (bao gm c
vic gia hn thi hn np HSKTG nu cn thit) bng cch gi vn bn sa
i HSMKTG n tt c cc doanh nghip nhn HSMKTG trc thi im
ht hn np HSKTG ti thiu 20 ngy. Ti liu ny l mt phn ca
HSMKTG. Doanh nghip phi thng bo cho B l nhn c cc ti
liu sa i bng mt trong nhng cch sau: gi vn bn trc tip, theo
ng bu in, fax hoc e-mail.
Mc 5. Chi ph tham gia la chn Ch u t
Doanh nghip chu mi chi ph lin quan n qu trnh tham gia la chn
Ch u t, k t khi nhn HSMKTG cho n khi c thng bo kt qu ng
k tham gia la chn Ch u t.
B. CHUN B H S NG K THAM GIA
Mc 6. Ngn ng s dng
28
HSKTG cng nh tt c vn bn, ti liu trao i gia B v doanh

nghip lin quan n vic mi ng k tham gia phi c vit bng ngn ng
ting Vit.
Mc 7. Ni dung HSKTG
HSKTG do doanh nghip chun b phi bao gm nhng ni dung sau:
1. Ti liu chng minh t cch hp l;
2. Ti liu k khai theo Bng 01 Mu 03/HT Ph lc ban hnh km theo
Thng t ny.
Mc 8. Th ng k tham gia la chn Ch u t
Th ng k tham gia la chn Ch u t d n do doanh nghip chun
b v phi c ghi y theo Ph biu 01 Mu 03/HTPh lc ban hnh km
theo Thng t ny, c ch k ca ngi i din hp php ca doanh nghip.
Mc 9. Ti liu chng minh t cch hp l, nng lc v kinh nghim,
xut thc hin d n ca doanh nghip
1. Ti liu chng minh t cch hp l ca doanh nghip
a) Doanh nghip phi cung cp cc ti liu chng minh t cch hp l ca
mnh: Bn chp Giy chng nhn ng k doanh nghip c chng thc.
2. Ti liu chng minh nng lc v kinh nghim ca doanh nghip
a) Nng lc v kinh nghim ca doanh nghip c k khai theo Ph biu
02, 03 Mu 03/HT Ph lc ban hnh km theo Thng t ny.
3. xut thc hin d n
Doanh nghip phi xut phng n thc hin d n vi cc ni dung
c bn quy nh ti Ph biu 04 Mu 03/HT Ph lc ban hnh km theo Thng
t ny.
Mc 10. Quy cch ca HSKTG
1. Doanh nghip phi chun b mt bn gc v hai bn chp HSKTG,
ghi r bn gc v bn chp tng ng.
2. Doanh nghip phi chu trch nhim v tnh chnh xc v ph hp gia
bn chp v bn gc.
3. HSKTG phi c nh my, in bng mc khng ty c, nh s
trang theo th t lin tc. Th ng k tham gia; cc vn bn b sung, lm r
HSKTG v cc biu khc phi c i din hp php ca doanh nghip k
theo hng dn ti Mu 03/HT Ph lc ban hnh km theo Thng t ny.
C. NP H S NG K THAM GIA
Mc 11. Nim phong v cch ghi trn ti ng HSKTG
1. HSKTG bao gm cc ni dung nu ti Mc 7 Chng ny. HSKTG
phi c ng trong ti c nim phong bn ngoi (cch nh du nim phong
29
do doanh nghip t quy nh). Cch trnh by cc thng tin trn ti ng

HSKTG nh sau:
- HSKTG: _____
- Tn, a ch, in thoi ca doanh nghip: _______.
- a ch np HSKTG : B Thng tin v Truyn thng, 18 Nguyn Du,
H Ni.
- Tn d n: ________ [Ghi tn d n].
- Khng c m trc ____ gi, ngy ___ thng ___ nm ____
Trng hp sa i HSKTG, ngoi cc ni dung trn cn phi ghi thm
dng ch "H s ng k tham gia sa i.
2. Trong trng hp HSKTG gm nhiu ti liu, doanh nghip cn thc
hin vic ng gi ton b ti liu sao cho vic tip nhn v bo qun HSKTG
ca B c thun tin, m bo s ton vn ca HSKTG, trnh tht lc, mt
mt.
3. Doanh nghip phi chu trch nhim v hu qu hoc s bt li nu
khng tun theo quy nh trong HSMKTG nh khng nim phong hoc lm
mt nim phong HSKTG trong qu trnh chuyn ti B, khng ghi ng cc
thng tin trn ti ng HSKTG theo hng dn ti Khon 1, 2 Mc ny. B s
khng chu trch nhim v tnh bo mt thng tin ca HSKTG nu doanh
nghip khng thc hin ng ch dn ti Khon 1 v Khon 2 Mc ny.
Mc 12. Thi hn np HSKTG
1. Doanh nghip np trc tip hoc gi HSKTG n a ch ca B
nhng phi m bo B nhn c trc ___ gi, ngy ___ thng ___
nm ____. B tip nhn HSKTG ca tt c doanh nghip np HSKTG trc
thi im ht hn np HSKTG, k c trng hp doanh nghip cha nhn
HSMKTG trc tip t B.
2. B c th gia hn thi hn np HSKTG trong trng hp cn tng
thm s lng HSKTG hoc khi sa i HSMKTG theo Mc 4 Chng ny
hoc theo yu cu ca doanh nghip khi B xt thy cn thit.
3. Khi gia hn thi im ht hn np HSKTG B s thng bo bng vn
bn cho cc doanh nghip nhn HSMKTG hoc np HSKTG, ng
thi ng ti thng bo gia hn thi im ht hn np HSKTG trn cng thng
tin in t ca B. Khi thng bo, B s ghi r thi im ht hn np HSKTG
mi doanh nghip c thi gian sa i hoc b sung HSKTG (bao gm
c hiu lc ca HSKTG) theo yu cu mi. Doanh nghip np HSKTG c
th nhn li sa i, b sung HSKTG ca mnh. Trng hp doanh nghip
cha nhn li hoc khng nhn li HSKTG th B qun l HSKTG theo
ch qun l h s mt.
Mc 13. HSKTG np mun
30
HSKTG c gi n B sau thi im ht hn np HSKTG s khng

c m, khng hp l, b loi v c tr li cho doanh nghip theo nguyn
trng. Bt k ti liu no c doanh nghip gi n sau thi im ht hn np
HSKTG sa i, b sung HSKTG np u khng hp l, tr ti liu
doanh nghip gi n lm r HSKTG theo yu cu ca B hoc ti liu lm
r, b sung nhm chng minh t cch hp l, nng lc v kinh nghim ca
doanh nghip quy nh ti Mc 16 Chng ny.
Mc 14. Sa i, thay th hoc rt HSKTG
1. Sau khi np, doanh nghip c th rt, thay th hoc sa i HSKTG
bng cch gi vn bn thng bo c ch k ca ngi i din hp php ca
doanh nghip, km theo ni dung thay th hoc sa i HSKTG. Mi thng
bo phi c doanh nghip chun b v np cho B theo quy nh ti Mc 11
Chng ny, trn ti ng vn bn thng bo phi ghi r RT H S NG
K THAM GIA hoc THAY TH H S NG K THAM GIA hoc
SA I H S NG K THAM GIA. B phi nhn c thng bo ny
ca doanh nghip trc thi im ht hn np HSKTH theo quy nh ti Mc
12 Chng ny.
2. HSKTG m doanh nghip yu cu rt li theo Khon 1 Mc ny s
c tr li cho doanh nghip theo nguyn trng. Doanh nghip khng c rt,
thay th hoc sa i HSKTG sau thi im ht hn np HSKTG cho n
khi ht hn hiu lc ca HSKTG nu trong th ng k thc hin hoc n khi
ht hn hiu lc gia hn ca HSKTG.
D. KT QU NG K THAM GIA
Mc 15. iu kin c la chn Ch u t
Doanh nghip c xem xt, la chn l Ch u t khi p ng y
cc iu kin sau:
1. C HSKTG hp l;
2. C HSKTG c gi thp nht hoc gi nh gi thp nht.
Mc 16. Thng bo kt qu ng k tham gia
Sau khi c quyt nh ph duyt kt qu ng k tham gia la chn ch
u t, B ng ti thng tin v kt qu ng k tham gia trn cng thng tin
in t ca B, ng thi gi vn bn thng bo kt qu ng k tham gia ti
cc doanh nghip tham gia.
Chng II
CC THNG TIN C BN CA D N
Chng ny cung cp cc thng tin lin quan n d n, phc v cho vic
lp xut thc hin d n ca mi doanh nghip vin thng. Cc ni dung c
bn bao gm:
1. Gii thiu chung v d n
31
[Nu thng tin tm tt v d n nh tn d n, ngun vn, ni dung h

tr, mc h tr ti a,]
2. M t s b v ni dung d n
[Nu thng tin tm tt v mc tiu, quy m, a im, cc ni dung chnh
thc hin ca d n, tm tt yu cu k thut, cng ngh ca d n....]
3. K hoch thc hin
[Nu d kin thi gian thc hin d n]
32
Mu 03/HT
H S NG K THAM GIA
Doanh nghip chun b cc ti liu quy nh ti Bng 01 di y:
Bng 01. H thng mu biu
S
TT
Ti liu
Biu mu p dng
Th ng k tham gia la chn Ch u t
Mu 03/HT/Ph biu 01
Kinh nghim ca doanh nghip
Mu 03/HT/Ph biu 02
K khai nng lc ti chnh ca doanh nghip
Mu 03/HT/Ph biu 03
xut thc hin d n
Mu 03/HT/Ph biu 04
Mu 03/HT/Ph biu01
TH NG K THAM GIA LA CHN CH U T
__________, ngy ___ thng ___ nm ___
Knh gi: B Thng tin v Truyn thng
Sau khi nghin cu h s mi ng k tham gia la chn Ch u t (bao
gm vn bn sa i h s mi quan tm, nu c), chng ti, Doanh nghip
____[Ghi tn doanh nghip], ng k tham gia la chn Ch u t d
n ______ [Ghi tn d n].
Chng ti gi xut d n km theo Th ng k tham gia la chn
Ch u t trnh by phng n d kin thc hin d n ______ [Ghi tn d
n].
Nu c la chn lm Ch u t d n, chng ti cam kt thc hin d
n ______ [Ghi tn d n] theo nhng ni dung ca xut thc hin d n
trnh by.
Chng ti cam kt cc thng tin k khai trong h s ng k tham gia ny
l chnh xc, trung thc.
i din hp php ca doanh nghip
33
Mu 03/HT/Ph biu02
KINH NGHIM CA DOANH NGHIP
Cc d n tng t do doanh nghip thc hin trong vng 01 nm gn
y.
Doanh nghip s dng bng sau k khai cho mi d n tng t nh
c yu cu trong d n ny m doanh nghip thc hin.
Tn d n
a im thc hin
Tn ch u t
Tng mc u t ca d n
Thi gian thc hin hp ng (ghi theo thi gian quy
nh trong hp ng; nu r t ngy.... n ngy...)
Thi gian thc t thc hin (nu r t ngy... n
ngy)
Doanh nghip phi gi km theo bn chp cc vn bn, ti liu lin quan.
34
Mu 03/HT/Ph biu03
K KHAI NNG LC TI CHNH CA DOANH NGHIP
________, ngy ___ thng ___ nm ___
Tn doanh nghip: _______________________ [Ghi tn doanh nghip]
A. Tm tt cc s liu v ti chnh trong 03 nm ti chnh gn y.
n v tnh: t ng
Stt
Ni dung
Tng ti sn
Tng n phi tr
Ti sn ngn hn
Tng n ngn hn
Doanh thu
Li nhun trc thu
Li nhun sau thu
Nm____
Nm____
Nm____
B. Ti liu gi nh km nhm i chng vi cc s liu m doanh

nghip k khai, doanh nghip np Bo co ti chnh c kim ton v bn chp
c chng thc ca mt trong cc ti liu sau:
1. T khai quyt ton thu c xc nhn ca c quan qun l thu hoc t
khai quyt ton thu in t trong 03 nm ti chnh gn y;
2. Vn bn xc nhn ca c quan qun l thu (xc nhn s np c nm)
v vic thc hin ngha v np thu trong 03 nm ti chnh gn y;
35
Mu 03/HT/Ph biu04
XUT THC HIN D N
__________, ngy ___ thng ___ nm ___
D n: [Ghi tn ca d n]
Doanh nghip xut d n: [Ghi tn doanh nghip]
NI DUNG XUT
1. S ph hp ca d n vi quy hoch, k hoch pht trin ngnh, vng
v k hoch pht trin kinh t - x hi ca a phng;
2. D kin mc tiu, quy m, a im thc hin d n;
3. Phn tch la chn s b v cng ngh, k thut, tiu chun, cht lng
cng trnh d n, sn phm hoc dch v cung cp;
4. D kin thi gian thc hin d n;
5. Phng n t chc qun l, kinh doanh hoc cung cp dch v;
6. Phn tch s b phng n ti chnh ca d n gm nhng ni dung: s
b Tng mc u t, c cu ngun vn v phng n huy ng;
7. D kin s b hiu qu kinh t - x hi ca d n; nh hng ca d n
i vi mi trng, x hi v quc phng, an ninh;
8. Nhng ni dung cn thit khc (nu cn);
9. xut kinh ph h tr thc hin d n: [Ghi s tin bng s v ch],
Bao gm cc loi chi ph sau:
- Chi ph xy dng: [lit k chi tit tng loi chi ph thnh phn v kinh
ph tng ng] (nu c);
- Chi ph thit b: [lit k chi tit tng loi chi ph thnh phn v kinh ph
tng ng] (nu c);
- Chi ph qun l d n: [lit k chi tit tng loi chi ph thnh phn v
kinh ph tng ng] (nu c);
- Chi ph khc: [lit k chi tit tng loi chi ph thnh phn v kinh ph
tng ng] (nu c);
- Chi ph d phng: [mc d phng] (nu c);
10. Thit k s b ca d n (nu l d n h tr thit lp h tng vin
thng bng rng).
36
Mu 01/DV n ng k thu bao

Ph biu 01(1)
N NG K THU BAO C HNG H TR
/2016/TT-BTTTT ngy / /2016 ca
B Thng tin v Truyn thng)
N NG K THU BAO HNG H TR
Knh gi: Doanh nghip [Tn doanh nghip cung cp dch v].
Tn ti l: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S CMND . . . . . . . . . . . . . ni cp . . . . . . . . . . . . . ngy cp. . . . . . . .
Ch hin ti2): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
L ch h gia nh, m s h [m s h] (nu c) thuc din:
H ngho
H cn ngho theo quy nh ca Nh nc.
Hin nay, gia nh ti ang s dng dch v: 3). . . . . . . . . . . . . . . . . .
S thu bao: . . . . . . . . . , do Doanh nghip [Tn doanh nghip cung cp
dch v] cung cp, tn thu bao: [tn thu bao trong hp ng] l thnh vin
trong h gia nh ti.
S hp ng: . . . . . . . . . . . . . . ., ngy k hp ng: . . . . . . . . . . . . . .
Ti lm n ny cam kt h gia nh ti cha c hng h tr (hoc
ngng c hng h tr i vi [Tn doanh nghip ng k ngng c
hng h tr]) v ng k S thu bao trn c hng h tr thuc Chng
trnh vin thng cng ch n nm 2020.
Ti xin cam oan cc thng tin nu trn l ng s tht v xin chu trch
nhim trc php lut v cc thng tin trn.
Trn trng cm n./.
., ngythngnm
CH H4)
(K v ghi r h tn)
Ghi ch:
1)
n ny s dng trong trng hp ch h ng k thu bao hng h tr.
2)
Ch hin ti ghi r thn, x, huyn, tnh (Thnh ph).
3)
Ghi r tn dch v ang s dng: in thoi c nh mt t tr sau hoc dch v thng tin
di ng mt t tr sau.
4)
Ch h lu nhn li giy bin nhn t doanh nghip sau khi np n ng k.

37
Ph biu 02(1)
N NG K THU BAO C HNG H TR
/2016/TT-BTTTT ngy / / 2016 ca
N NG K THU BAO HNG H TR
Tn n v: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a ch: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ngi i din . . . . . . . . . . . . . Chc v: . . . . . . .
Hin nay, chng ti ang s dng dch v: 2). . . . . . . . . . . . . . . . . .
Thu bao: . . . . . . . . . , gi cc:[tn gi cc] do Doanh nghip [Tn
doanh nghip cung cp dch v] cung cp.
S hp ng: . . . . . . . . . . . . . . ., ngy k hp ng:3). . . . . . . . . . . . . .
Chng ti lm n ny cam kt n v chng ti cha c hng h tr
(hoc ngng c hng h tr i vi [Tn doanh nghip ng k
ngng c hng h tr]) v ng k Thu bao, gi cc trn c hng h
tr thuc Chng trnh vin thng cng ch n nm 2020.
Chng ti xin cam oan cc thng tin nu trn l ng s tht v xin chu
trch nhim trc php lut v cc thng tin trn.
Trn trng cm n./.
., ngythngnm
I DIN N V NG K3)
(K v ghi r h tn)
Ghi ch:
1)
n ny s dng trong trng hp n v ng k thu bao hng h tr.
2)
Ghi r tn dch v ang s dng l dch v truy nhp Internet bng rng c nh tr sau;
dch v knh thu ring c nh mt t hoc dch v truyn dn tn hiu truyn hnh s (ghi
r tn chng trnh truyn hnh) qua bng tn Ku ca v tinh VINASAT, dch v thu knh
truyn dn cp quang ca Tp on in lc Vit Nam.
n v lu nhn li giy bin nhn t doanh nghip sau khi np n ng k.
38
Ph biu 031)
N NG K NGNG THU BAO C HNG H TR
/2016/TT-BTTTT ngy / / 2016 ca
B trng B Thng tin v Truyn thng)
N NG K NGNG THU BAO HNG H TR
Tn ti l: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S CMND . . . . . . . . . . . . . ni cp . . . . . . . . . . . . . ngy cp. . . . . . . .
Ch hin ti2): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
L ch h gia nh, m s h [m s h] (nu c) thuc din:
H ngho
H cn ngho theo quy nh ca Nh nc.
Hin nay, gia nh ti ang s dng dch v: 3). . . . . . . . . . . . . . . . . .
S thu bao: . . . . . . . . . , do Doanh nghip [Tn doanh nghip cung cp
dch v] cung cp, tn thu bao:[tn thu bao trong hp ng]l thnh vin
trong h gia nh ti.
S hp ng: . . . . . . . . . . . . . . ., ngy k hp ng: . . . . . . . . . . . . . .
Ti lm n ny ng k S thu bao trn ngng c hng h tr
thuc Chng trnh vin thng cng ch n nm 2020.
Ti xin cam oan cc thng tin nu trn l ng s tht v xin chu trch
nhim trc php lut v cc thng tin trn.
Trn trng cm n./.
., ngythngnm
CH H4)
(K v ghi r h tn)
Ghi ch:
1)
n ny s dng trong trng hp ch h ng k thu bao ngng hng h tr.
2)
Ch hin ti ghi r thn, x, huyn, tnh (Thnh ph).
3)
Ghi r tn dch v ang s dng: in thoi c nh mt t tr sau hoc dch v thng tin
di ng mt t tr sau.
4)
Ch h lu nhn li giy bin nhn t doanh nghip sau khi np n ng k.
39
Ph biu 041)
N NG K THU BAO NGNG C HNG H TR
/2016/TT-BTTTT ngy / /2016 ca
N NG K THU BAO NGNG HNG H TR
Tn n v: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a ch: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ngi i din . . . . . . . . . . . . . Chc v: . . . . . . .
Hin nay, chng ti ang s dng dch v: 2). . . . . . . . . . . . . . . . . .
Thu bao: . . . . . . . . . , gi cc: [tn gi cc] do Doanh nghip [Tn
doanh nghip cung cp dch v] cung cp.
S hp ng: . . . . . . . . . . . . . . ., ngy k hp ng:3). . . . . . . . . . . . . .
Chng ti lm n ny ng k Thu bao, gi cc trn ngng c
hng h tr thuc Chng trnh vin thng cng ch n nm 2020.
Chng ti xin cam oan cc thng tin nu trn l ng s tht v xin chu
trch nhim trc php lut v cc thng tin trn.
Trn trng cm n./.
., ngythngnm
I DIN N V NG K3)
(K v ghi r h tn)
Ghi ch:
1)
n ny s dng trong trng hp n v ng k thu bao ngng c hng h tr.
2)
Ghi r tn dch v ang s dng l dch v truy nhp Internet bng rng c nh tr sau;
dch v knh thu ring c nh mt t hoc dch v truyn dn tn hiu truyn hnh s (ghi
r tn chng trnh truyn hnh) qua bng tn Ku ca v tinh VINASAT, dch v thu knh
truyn dn cp quang ca Tp on in lc Vit Nam.
3)
n v lu nhn li giy bin nhn t doanh nghip sau khi np n ng k.
40
Mu 02/DV - Danh sch i tng th hng

Doanh nghip:
Tnh:
MU 02/DV Ph biu 01
(Ban hnh km theo TT s./2016/TT-BTTTT)
DANH SCH H NGHO, H CN NGHO C HNG H TR I VI DCH V IN THOI C NH MT

T TR SAU V DCH V THNG TIN DI NG MT T TR SAU
Nm . . . .
ST
T
M
huyn
M x
A
1
2
3
4
.
Tn ch
h
M s h
a ch
3
Tn thu
bao
4
S in thoi ng
k
C nh
Di ng
S hp
ng
8
Ngy,
thng,
nm
ng
k
9
Ghi ch
10
.., ngy.thng .. nm
XC NHN CA S THNG TIN V TRUYN THNG
GIM C
(K, ghi r h tn, ng du)
Ghi ch:
- Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin t n ng k thu bao c h tr ca h ngho, h cn
ngho v S Thng tin v Truyn thng xc nhn sau khi kim tra, m bo mi h ngho, h cn ngho ch c hng h tr cho mt
thu bao in thoi. S Thng tin v Truyn thng gi bn mm v Ban Qun l Chng trnh.
- Hng qu, doanh nghip lp danh sch thu bao pht sinh tng, danh sch thu bao gim theo ni dung Ph biu ny.
41
Cch lp biu:
Ct (A): Ghi s th t ca h.
Ct (B), ct (C): Ghi m huyn, m x (theo quy nh ti Quyt nh s 124/2004/Q-TTG v vic ban hnh Bng danh mc v m s cc
n v hnh chnh Vit Nam) ca a ch h ngho, h cn ngho.
Ct (1): Ghi h v tn ca ch h.
Ct (2): Ghi m s h ngho, h cn ngho.
Ct (3): Ghi a ch ca h: s nh, thn/bn/khi ph ca h ngho, cn ngho.
Ct (4): Ghi h tn ch thu bao trong h s hu s in thoi ng k c h tr.
Ct (6): Ghi s in thoi c nh mt t tr sau (C) ng k hng h tr.
Ct (7): Ghi s in thoi di dng mt t tr sau (D).
Ct (8): Ghi s hp ng ca thu bao ng k hng h tr.
Ct (9): Ghi ngy, thng, nm i tng ng k hng h tr hoc ng k ngng h tr (i vi danh sch gim).
42
Doanh nghip:
Tnh:
MU 02/DV Ph biu 02
DANH SCH TRNG HC, BNH VIN, Y BAN NHN DN CP X C HNG H TR I VI DCH V
TRUY NHP INTERNET BNG RNG C NH TR SAU
Nm . . . . .
STT M huyn
A
1
2
3
4
5
..
M x
Tn trng hc,
bnh vin, y ban
nhn dn cp x
a ch lp
t
S hp
ng

Ngy,
M truy Gi cc thng, nm
nhp
truy nhp ng k h
tr
4
5
6
Ghi ch
7
.., ngy.thng .. nm
GIM C
Ghi ch: - Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin t n ng k thu bao c hng h tr ca
cc trng hc, bnh vin, UBND cp x v S Thng tin v Truyn thng xc nhn sau khi kim tra, m bo mi trng hc,
bnh vin, UBND cp x ch c hng h tr cho mt gi cc. S Thng tin v Truyn thng gi bn mm v Ban Qun l
Chng trnh.
- Hng qu, doanh nghip lp danh sch trng hc, bnh vin, UBND cp x pht sinh tng, danh sch trng hc, bnh
vin, UBND cp x gim theo ni dung Ph biu ny.
43
Cch lp biu:
Ct (A): Ghi s th t ca trng hc, bnh vin, UBND cp x.
Ct (B), ct (C): Ghi m huyn, m x (theo quy nh ti Quyt nh 124/2004/Q-TTG v vic ban hnh Bng danh mc v m s
cc n v hnh chnh Vit Nam) ca a ch trng hc, bnh vin, UBND cp x.
Ct (1): Ghi tn ca trng hc, bnh vin, UBND cp x iu kin c hng h tr.
Ct (2): Ghi a ch lp t thu bao.
Ct (3): Ghi s hp ng m trng hc, bnh vin, UBND cp x trn k kt vi doanh nghip cung cp dch v.
Ct (4): Ghi m truy nhp.
Ct (5): Ghi gi cc trong hp ng k.
Ct (6): Ghi ngy, thng, nm i tng ng k hng h tr hoc ng k ngng h tr (i vi danh sch gim)
44
Doanh nghip:
Tnh:
DANH SCH IM CUNG CP DCH V TRUY NHP INTERNET CNG CNG

C H TR DUY TR
Nm . . . . .
STT
A
1
2
3
4
.
M
huyn
M x
Tn im truy
nhp
Thuc
Thit lp
CT74
mi
2
1
a ch
S hp
ng
M truy
nhp
Gi cc
truy nhp
S my tnh
truy nhp
.., ngy.thng .. nm
XC NHN CA S THNG TIN V
TRUYN THNG
GIM C
Ghi ch:
Ph biu ny do doanh nghip qun l vn hnh im truy nhp lp v c S Thng tin v Truyn thng xc nhn sau khi kim tra,
m bo mi im truy nhp thuc i tng h tr. S Thng tin v Truyn thng gi bn mm v Ban Qun l Chng trnh.
- Hng qu, doanh nghip lp danh sch im truy nhp Internet cng cng pht sinh tng, danh sch im truy nhp Internet cng cng
gim theo ni dung Ph biu ny.
Cch lp biu:
45
Ct (A): Ghi s th t ca im truy nhp Internet cng cng.

Ct (B), ct (C): Ghi m huyn, m x (theo quy nh ti Quyt nh 124/2004/Q-TTG v vic ban hnh Bng danh mc v m s cc n v hnh c
Ct (1): Ghi tn ca im truy nhp Internet cng cng iu kin hng h tr thuc Chng trnh 74.
Ct (2): Ghi tn ca im truy nhp Internet cng cng iu kin hng h tr thit lp mi (500 im).
Ct (3): Ghi a ch im truy nhp Internet cng cng.
Ct (4): Ghi s hp ng cung cp dch v Internet cng cng.
Ct (5): Ghi m truy nhp
Ct (6): Ghi gi cc trong hp ng k
Ct (7): Ghi s lng my tnh truy nhp Internet trc tip cung cp dch v truy nhp
Internet cho ngi s dung dch v
46
Doanh nghip:
Tnh:
MU 02/DV Ph biu 04
DANH SCH BNH VIN IU KIN HNG H TR P DNG I VI DCH V

KNH THU RING C NH MT T
Nm . . . . . .
STT
M huyn
M x
Tn bnh vin
a ch lp t
S hp ng
A
1
2
Thi hn
hp ng
4
M knh
5
Ghi
ch
6
.., ngy.thng .. nm
GIM C
Ghi ch: - Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin t n ng k knh thu ring c hng h tr
ca bnh vin v S Thng tin v Truyn thng xc nhn sau khi kim tra, m bo mi bnh vin ch c hng h tr cho mt
knh thu ring.
- Hng qu, doanh nghip lp danh sch knh thu ring pht sinh tng, danh sch knh thu ring gim theo ni dung Ph biu ny.
Cch lp biu:
Ct (A): Ghi s th t ca bnh vin.
Ct (B), ct (C): Ghi m huyn, m x (theo quy nh ti Quyt nh 124/2004/Q-TTG v vic ban hnh Bng danh mc v m s cc
n v hnh chnh Vit Nam) ca bnh vin.
Ct (1): Ghi tn ca bnh vin iu kin c hng h tr v ang s dng knh thu ring c nh mt t.
Ct (2): Ghi a ch bnh vin.
Ct (3): Ghi s hp ng m bnh vin v tinh trn k kt vi doanh nghip cung cp dch v cho knh 2Mbps c d phng.
Ct (4): Ghi thi hn hp ng.
47
Ct (5): Ghi m knh.

Doanh nghip:
Tnh:
MU 02/DV Ph biu 05
(Ban hnh theo TT s./2016/TT-BTTTT)
DANH SCH THU BAO C H TR CUNG CP DCH V VIN THNG DI NG HNG HI

QUA H THNG I THNG TIN DUYN HI
Nm
ST
T
M
huyn
M
x
Tn ch thu
bao
Bin s
tu
a ch ch
thu bao
M thu
bao
S hp ng
A
1
2
S giy chng
nhn ng k
tu c
6
Ghi ch
7
.., ngy.thng .. nm
XC NHN CA S THNG TIN V
TRUYN THNG
GIM C
Ghi ch: - Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin thu bao thng tin di ng hng hi ca cc ng
dn nh bt hi sn c hng h tr v S Thng tin v Truyn thng xc nhn sau khi kim tra, xc nhn. S Thng tin v Truyn
thng gi bn mm v Ban Qun l Chng trnh.
- Hng qu, doanh nghip lp danh sch thu bao pht sinh tng, danh sch thu bao gim theo ni dung Ph biu ny.
Cch lp biu:
Ct (A): Ghi s th t ca thu bao.
Ct (B), ct (C): Ghi m huyn, m x (theo quy nh ti Quyt nh 124/2004/Q-TTG v vic ban hnh Bng danh mc v m s cc
n v hnh chnh Vit Nam) ca a ch ch thu bao.
Ct (1): Ghi tn ca ch thu bao iu kin c hng h tr.
48
Ct (2): Ghi bin s tu nh bt hi sn

Ct (3): Ghi a ch ch thu bao
Ct (4): Ghi m thu bao
Ct (5): S hp ng k
Ct (6): S giy chng nhn ng k tu c
49
Doanh nghip:
MU 02/DV Ph biu 06
DANH SCH I PHT THANH TRUYN HNH C H TR CUNG CP DCH V

TRUYN DN TN HIU TRUYN HNH S S DNG BNG TN KU CA V TINH VINASAT
Nm . . . . . .
STT
A
1
2
.
Tn tnh/thnh
ph
Tn i pht thanh
truyn hnh
a ch i
S hp ng
Thi hn hp
ng

Tn knh
chng trnh
truyn hnh
5
Ghi ch
6
.., ngy.thng .. nm
GIM C
Ghi ch: - Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin thu ng truyn v tinh c hng h tr ca
i pht thanh truyn hnh cp tnh v S Thng tin v Truyn thng xc nhn sau khi kim tra.
- Hng qu, doanh nghip lp danh sch knh chng trnh truyn hnh pht sinh tng, danh sch knh chng trnh truyn hnh
gim theo ni dung Ph biu ny.
Cch lp biu:
Ct (A): Ghi s th t ca i.
Ct (1): Ghi tn ca i truyn hnh iu kin c hng h tr.
Ct (2): Ghi a ch i.
Ct (3): Ghi s hp ng m doanh nghip vin thng k kt vi i.
Ct (4): Thi hn hp ng.
Ct (5): Ghi tn knh chng trnh truyn hnh.
50
Doanh nghip:
Tnh:
Mu 03/DV Ph biu 01

K HOCH SN LNG V KINH PH H TR CUNG CP DCH V IN THOI C NH MT T TR SAU V
DCH V THNG TIN DI NG MT T TR SAU CHO H NGHO, H CN NGHO
Nm
DCH V MNG IN THOI C NH
ST
T
A
1
2
M
huyn
Tn
S lng
huyn thu bao n
S liu c nm
thc hin
30/6 nm
thc hin
Sn lng
(lt thu
bao)
DCH V MNG IN THOI DI NG
S liu nm k
hoch
S liu c nm
thc hin
S liu nm k
hoch
Ghi ch
S lng thu
bao n 30/6
Sn lng
Sn lng
Sn lng
Kinh ph
Kinh ph nm thc hin
Kinh ph
Kinh ph
(lt thu
(lt thu
(lt thu
(ng)
(ng)
(ng)
(ng)
bao)
bao)
bao)
10
11
Cng:
NGI LP BIU
(K ghi r h tn)
. ngy . thng . nm ..
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (1), ct (6) s lng thu bao thuc h ngho, h cn ngho hin c n ngy 30/6.
- Ct (2), (7) sn lng lt thu bao l s lng thu bao nhn s thng h tr, v d mt thu bao c h tr 12 thng th sn lng c tnh
12 lt.
- Ct (3), Ct (5), ct (8) ct (10), kinh ph bng Mc h tr nhn vi Sn lng (lt thu bao).
- S liu c nm thc hin l s liu thc hin Qu 1,2 v s liu c thc hin Qu 3,4 ca nm thc hin.
- Doanh nghip tng hp s liu Ton quc theo m tnh, tn tnh vi ni dung nh Mu 03/DV Ph biu 01.
51
Doanh nghip:
Tnh:
Mu 03/DV Ph biu 02
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V TRUY NHP INTERNET

BNG RNG C NH TR SAU CHO TRNG HC, BNH VIN, Y BAN NHN DN CP X
Nm
ST
T
A
I
1
Tn huyn
M
huyn
Sn
S liu c nm
lng
thc hin
thu bao
Kinh
n 30/6 Sn lng
ph
nm thc (lt thu
bao)
(ng)
hin
1
2
3
S liu nm k hoch
Sn lng
(lt thu
bao)
Mc h tr
(ng)
Kinh ph
(ng)
6=4*5
Ghi ch
Huyn A
Trng hc
Gi cc 1 (4 Mbps)
Gi cc 3 (32 Mbps)
Gi cc 4 (45 Mbps)
Bnh vin
Gi cc 2 (12 Mbps)
Gi cc 3 (32 Mbps)
Gi cc 4 (45 Mbps)
UBND x
Gi cc 1 (4 Mbps)
II
Huyn B
52
..
Cng (I + II..)
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- Doanh nghip tng hp s liu ton quc theo m tnh, tn tnh vi ni dung nh Mu 03/DV Ph biu 02.
53
Mu 03/DV Ph biu 03
Doanh nghip:
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V VIN THNG DI NG HNG HI

Nm
STT
A
1
Tnh/Thnh ph
S lng
thu bao
n 30/6
nm thc
hin
S liu c nm thc hin
S liu nm k hoch
Ghi ch
Sn lng
(lt thu
bao)
Sn lng
lin lc
(pht)
Kinh ph
(ng)
Sn lng
(lt thu
bao)
Sn lng
lin lc
(pht)
Kinh ph
(ng)
Tnh A
C nh ni tnh
C nh lin tnh
Di ng
Tnh B
Cng:
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- S liu c nm thc hin l s liu thc hin Qu 1, 2 v s liu c thc hin Qu 3,4 ca nm thc hin.
- Kinh ph bng Mc h tr nhn vi Sn lng lin lc (pht).
54
Doanh nghip:
Tnh:
Mu 03/DV ph biu 04
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V KNH THU RING C NH MT T

Nm
ST
T
1
2
3
4
5
6
7
Tn huyn
M huyn
S lng
knh n
30/6 nm
thc hin
1
S liu c nm thc hin

Sn lng
(lt knh)
2
Kinh ph
(ng)
3
S liu nm k hoch
Sn lng
(lt knh)
4
Kinh ph
(ng)
5
Ghi ch
Cng:
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (3), ct (5) kinh ph bng Mc h tr nhn vi Sn lng (lt knh).
- Doanh nghip tng hp s liu Ton quc theo m tnh, tn tnh vi ni dung nh Mu 03/DV Ph biu 04.
55
Doanh nghip:
Mu 03/DV Ph biu 05
K HOCH SN LNG V KINH PH H TR THIT LP NG TRUYN DN CP QUANG RA HUYN O

Nm
ST
T
1
2
3
4
5
S liu c nm thc hin

Tn huyn
M huyn
Gi tr ha n
Kinh ph h tr
(ng)
2
S liu nm k hoch
Gi tr ha n
3
Kinh ph h tr
(ng)
4
Ghi ch
Cng:
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (2), ct (4) kinh ph bng t l h tr nhn vi gi tr trc thu VAT trn ha n thu si cp quang.
56
Doanh nghip:
Mu 03/DV ph biu 06
Tnh:...
K HOCH SN LNG V KINH PH H TR DUY TR IM TRUY NHP INTERNET CNG CNG

Nm
STT
M huyn
M
huyn
A
2
3
4
5
6
7
S im c
n 30/6
nm thc
hin
1
S liu c nm thc hin

Sn lng
(lt im)
2
Kinh ph
(ng)
3
S liu nm k hoch
Sn lng
(lt im)
4
Kinh ph
(ng)
5
Ghi ch
Cng:
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (3), ct (5) kinh ph bng Mc h tr nhn vi Sn lng (lt im).
- Doanh nghip tng hp Ton quc theo m tnh, tn tnh vi ni dung nh Mu 03/DV Ph biu 06.
57
Mu 03/DV Ph biu 07
Doanh nghip:
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V TRUYN DN TN HIU TRUYN HNH S

PHC V TRUYN HNH S DNG BNG TN KU CA V TINH VINASAT
Nm
STT
A
2
3
4
5
6
7
Tn tnh
M tnh
S knh
chng trnh
n 30/6 nm
thc hin
1
S liu c nm thc hin
S liu nm k hoch
Ghi ch
Sn lng
(lt knh)
2
Kinh ph
(ng)
3
Sn lng
(lt knh)
4
Kinh ph
(ng)
5
Cng:
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (3), ct (5) kinh ph bng Mc h tr nhn vi Sn lng (lt knh).
58
Mu 03/DV Ph biu 08
Doanh nghip:
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V VIN THNG KHN CP

V H TR TRA CU S IN THOI C NH
Nm
STT
A
1
2
3
4
5
6
7
8
9
10
Tnh/Thnh ph
S dch v
S liu c nm thc
hin
S liu nm k hoch
Ghi ch
Sn lng
(pht)
Kinh ph
(ng)
Sn lng
(pht)
Mc h tr
(ng)
Kinh ph
(ng)
Tnh A
113
114
115
116
Tnh B
113
114
115
116
Cng:
NGI LP BIU
TRNG N V
(K ghi r h tn)
(K ghi r h tn)
Ghi ch: - S liu c nm thc hin l s liu thc hin Qu 1,2 v s liu c thc hin Qu 3,4 ca nm thc hin.
Mu 03/DV Ph biu 09
Doanh nghip:
59

K HOCH SN LNG V KINH PH H TR CUNG CP DCH V VIN THNG DI NG HNG HI PHC V
HOT NG TM KIM CU NN TRN BIN QUA H THNG I THNG TIN DUYN HI
Nm
S lng s kin n
STT
30/6 nm thc hin
A
1
2
3
4
NGI LP BIU
(K ghi r h tn)
S liu c nm thc hin
S liu nm k hoch
Sn lng (pht)
Kinh ph (ng)
Sn lng
(pht)
Kinh ph (ng)
Ghi ch
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (1) s lng s kin n 30/6 l tng s s kin pht sinh t u nm n ht 30/6 nm thc hin .
- Thi gian bt u v thi im kt thc s kin c tnh t thi im C quan ch tr tm kim, cu nn yu pht v dng pht thng tin
tm kim, cu nn v ngi, phng tin ang gp nguy him trn bin.
- Ct (3), ct (5) kinh ph bng Mc h tr nhn vi Sn lng (pht).
60
Mu 03/DV Ph biu 10
Doanh nghip:
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V VIN THNG PHC V HOT NG CH

O, IU HNH PHNG, CHNG THIN TAI
Nm
S liu c nm thc hin
STT
Dch v
Sn
lng
A
1
2
B
Thu knh bng C VINASAT
Thu bao VSAT-IP
Thu bao VSAT-IP

3
4
n v
2
knh
Kinh
ph
(ng)
3
S liu nm k hoch
Sn
lng
4
n v
5
knh
thu bao
thu bao
Thoi/Fax
pht
pht
Truy nhp Internet ca trm

VSAT-IP
Thu knh ring IP
ngy
ngy
2 Mbps
1 Mbps
512 Kbps
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
256 Kbps
ngy/knh
ngy/knh
128 Kbps
ngy/knh
ngy/knh
Ghi ch
Mc h tr
(ng)
Kinh ph
(ng)
7=5*6
61
64 Kbps
Thit lp mng dng ring
VPN
2 Mbps
1 Mbps
512 Kbps
256 Kbps
128 Kbps
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
ngy/knh
64 Kbps
Vin thng v tinh Inmarsat
ngy/knh
ngy/knh
Thoi/Fax/Truyn s liu ca
Inmarsat M n mng vin
thng c nh mt t
pht
pht
Inmarsat tr sau loi

IsatPhonePro
thu bao
thu bao
Inmarsat tr sau loi BGAN
thu bao
thu bao
Inmarsat tr trc
thu bao
thu bao
Cng
NGI LP BIU
(K ghi r h tn)
Doanh nghip:
TRNG N V
(K ghi r h tn)
Mu 03/DV Ph biu 11
62

K HOCH TNG HP KINH PH H TR CUNG CP DCH V VIN THNG CNG CH
Nm . . . . .
ST Tnh/Thnh
T
ph
A
1
2
3
4
5
B
An Giang
..
K hoch kinh ph theo dch v
Dch v T
c nh, i
ng
HN,HCN
Internet
TH, BV,
UB x
Di ng
hng hi
qua HF
Thu
knh c
nh
mt t
ng
truyn
dn cp
quang ra
o
im TN
Internet
cng
cng
Truyn
hnh s
dng
bng tn
Ku ca
vinasat
Dch v
khn
cp,
dch v
tra cu
T
Tm
kim
cu nn
trn
bin
qua HF
Hot ng
c/o
/hnh
phng
chng
thin tai
10
K
hoch
kinh
ph
theo
tnh
Ghi
ch
11
12
Cng:
NGI LP BIU
(K ghi r h tn)
Ghi ch:- S liu ct (9), ct (10) c tng hp trn ton quc.
TRNG N V
(K ghi r h tn)
63
Mu 04/DV
HP NG (MU)
T HNG CUNG NG DCH V VIN THNG CNG CH
(Km theo Thng t s
/2016/TT-BTTTT ngy .. thng . nm 2016 ca
---------------HP NG
T HNG CUNG CP DCH V VIN THNG CNG CH
S:
/H/VTCI
- Cn c B Lut Dn s ngy 14 thng 6 nm 2005;

- Cn c Lut Vin thng ngy 23 thng 11 nm 2009;
- Cn c Ngh nh s 25/2011/N-CPngy 06 thng 04 nm 2011ca
Chnh ph quy nh chi tit v hng dn thi hnh mt s iu ca Lut Vin
thng;
- Cn c Quyt nh s 1168/Q-TTg ngy 24/7/2015 ca Th tng
nm 2020;
- Cn c Quyt nh s
/Q-BTTTT ngy thng nm ca B
Thng tin v Truyn thng v vic ph duyt k hoch cung ng dch v vin
thng cng ch nm;
Hm nay, ngy
Hp ng, gm c:
thng
nm 20
, chng ti, i din cho cc Bn k
Bn A - Bn t hng cung cp dch v dch v vin thng cng ch - (Tn

Bn A):
Bn B - Bn nhn t hng cung cp dch v dch v vin thng cng
ch - (Tn Bn B):
Hai bn tha thun k Hp ng t hng cung cp dch v dch v vin
thng cng ch vi cc ni dung sau:
iu 1. Gii thch t ng:
Trong hp ng ny, cc t ng di y c hiu nh sau:
iu 2. i tng hp ng
Bn B nhn cung ng cc dch v vin thng cng ch nh cc Ph lc
km theo hp ng theo ng yu cu ca Bn A.
iu 3. Thnh phn Hp ng
Thnh phn Hp ng gm:
64
1. Vn bn Hp ng;
2. Cc Ph lc (s ph lc) km theo Hp ng. Cc ph lc l b phn
khng tch ri Hp ng ny.
3. Cc tha thun (nu c) gia hai bn tin hnh theo ng cc quy nh
ca hp ng.
iu 4. Tiu chun cht lng v gi cc
Bn B m bo thc hin vic cung ng cc dch v vin thng cng ch
nu ti iu 2 ca Hp ng p ng cc tiu chun cht lng v gi cc vin
thng cng ch theo quy nh hin hnh ca Nh nc.
iu 5. Khu vc, a im cung ng dch v vin thng cng ch
iu 6. Thi gian thc hin hp ng: Trong nm 20..
iu 7. Gi tr Hp ng
1. Tng gi tr ca Hp ng l (tm tnh):.......................... ng.
(S tin bng ch:......................... )
Hai bn thng nht s iu chnh gi tr Hp ng sau khi c Quyt nh
ph duyt k hoch kinh ph h tr cung ng dch v vin thng cng ch nm
20 . . . . ca B Thng tin v Truyn thng.
2. Trng hp Bn B thc hin cung ng dch v vin thng cng ch
vt ch tiu c t hng ti Hp ng ny do pht sinh i tng th hng
trong nm v lu lng lin lc thc t th hai bn thng nht p dng cc
nguyn tc thanh ton b sung.
iu 8. Tm ng, thanh ton kinh ph thc hin Hp ng
iu 9. Trch nhim ca Bn B
..
iu 10. Trch nhim ca Bn A
..
iu 11. Sa i, b sung Hp ng
1. Hai bn khng c t sa i, b sung cc ni dung hp ng k
kt.
2. Khi mt bn c nhu cu sa i, b sung ni dung Hp ng th phi
thng bo bn kia tin hnh thng tho thay i ni dung hp ng k
kt. Trong phm vi 10 ngy lm vic, Bn nhn c ngh c trch nhim tr
li bn kia cc kin cn sa i.
3. Mi tha thun v sa i, b sung Hp ng c hai bn th hin
bng Bin bn sa i b sung Hp ng v c lp thnh Ph lc sa i b
sung Hp ng c hai bn k kt v l b phn khng tch ri ca Hp ng.
65
iu 12. Vi phm Hp ng
1. Vi phm t Bn B:
a) Trng hp Bn B vi phm cc ni dung v gi cc, cht lng dch
v th Bn B chu hon ton trch nhim theo quy nh ca php lut. Trong
trng hp vi phm nghim trng, Bn A c quyn n phng chm dt Hp
ng theo kt lun ca c quan Nh nc c thm quyn.
b) Trng hp Bn B cung ng dch v vin thng cng ch khng ng
a im, khng ng i tng c h tr nh Hp ng, Bn A c quyn
khng thanh ton kinh ph h tr i vi sn lng dch v vin thng cung ng
khng ng theo Hp ng.
c) Trng hp Bn B khng thc hin ngha v bo co tnh hnh thc
hin cung ng cc dch v vin thng cng ch theo quy nh ca nh nc; Bn
A khng c ngha v phi bi thng cc thit hi kinh t cho Bn B do vic
khng nhn c tin tm ng, thanh ton kinh ph theo ng tin tha thun
trong Hp ng.
2. Vi phm t Bn A:
a) Trong trng hp Bn A tm ng, thanh ton kinh ph h tr chm cho
Bn B qu thi gian quy nh 01 thng, m khng c l do c Bn B chp
thun th phi tr li s tin chm thanh ton theo li sut tin vay trung hn ca
Ngn hng u t Pht trin Vit Nam cng thi im tng ng.
b) Trng hp Bn A t hy b, hoc thay i Hp ng m khng phi
do nhng l do bt kh khng nh khon 1 iu 14 di y th phi chu bi
thng thit hi cho Bn B. Mc bi thng do hai bn tha thun. Trng hp
hai bn khng tha thun c m mt hoc c hai bn a v vic ra Ta n,
hai bn thng nht chp thun theo phn quyt ca Ta n Thnh ph H Ni.
iu 13. Th tc chm dt Hp ng do vi phm
1. Nu mt trong hai bn c vi phm nghim trng nhng iu khon
k kt trong Hp ng th Bn kia c quyn n phng chm dt vic thc
hin mt phn hay ton b hp ng v trong vng 07 ngy v phi c vn bn
thng bo cho Bn kia bit.
2. Trong trng hp hp ng b chm dt thc hin mt phn th Bn A
c quyn k hp ng vi n v cung ng dch v vin thng cng ch khc
thc hin phn hp ng b chm dt. Bn B vn c trch nhim thc hin tip
phn hp ng khng b chm dt hiu lc.
iu 14. Trng hp bt kh khng
1. Hai bn thng nht rng, trong trng hp c quan nh nc c thm
quyn thay i chnh sch, ch , trng hp c chin tranh, bo lon, nh
cng, ha hon, l lt, dch bnh, cch ly do kim dch, cm vn l cc trng
hp bt kh khng cho tt c cc bn v khng bn no c quyn i hi vic b
p thit hi (nu c) t Bn cn li.
66
2. Khi xy ra trng hp bt kh khng, cc bn phi kp thi thng bo

bng vn bn cho nhau v cng phi hp gii quyt.
iu 15. Gii quyt tranh chp
1. Khi pht sinh tranh chp trc ht hai bn s tin hnh thng lng,
ha gii.
2. Trong trng hp hai bn vn khng tha thun c vi nhau th c
quyn gi yu cu n Ta n Thnh ph H Ni gii quyt.
iu 16. Phi hp lm vic v t chc thanh l Hp ng
iu 17. Hiu lc hp ng
1. Hp ng c hiu lc k t ngy k kt gia hai bn.
2. Hp ng ht hiu lc sau khi:
a) Hai bn hon thnh thanh l Hp ng;
b) Hp ng b c quan nh nc c thm quyn tuyn b v hiu.
Hp ng c lp thnh 8 b, mi b c trang, nh s th t t
trang 01 n trang (bao gm c cc Ph lc Hp ng) mi bn gi 04 b, cc
b Hp ng c gi tr php l nh nhau.
I DIN BN A
I DIN BN B
MU 05/DV - Bo co sn lng thc hin
67
Ph biu 01 - Cng vn ngh nghim thu sn lng, kinh ph h tr qu

Tn doanh nghip
S:.
V vic.......
......, ngy... thng.... nm ...
NGH NGHIM THU SN LNG, KINH PH H TR

Qu ..............
Knh gi: Ban Qun l Chng trnh vin thng cng ch
Thc hin Hp ng t hng . . . . . .. . .
Doanh nghip thc hin h tr cung cp dch v vin thng cng
ch Qu . . . nm ( c Ph lc bo co sn lng v kinh ph km theo)
..
.
ngh Ban Qun l Chng trnh cung cp dch v vin thng cng ch
t chc nghim thu theo quy nh
Lnh o doanh nghip

Ni nhn:
(K tn, ng du)
...
68
Doanh nghip:
MU 05/DV Ph biu 02
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VIN THNG CNG CH

Qunm ...
ST
T
Dch v
Dch v in thoi c nh mt t tr sau
Dch v thng tin di ng mt t tr sau
Dch v vin thng di ng hng hi phc

v hot ng tm kim cu nn trn bin
4
5
6
7
8
Sn lng h tr
Sn lng
1
n v
2
Kinh ph h tr
(ng)
Ghi ch
Dch v vin thng di ng hng hi qua

h thng i thng tin duyn hi
Dch v truy nhp Internet bng rng c
nh tr sau cho trng hc, bnh vin, y
ban nhn dn x
nh tr sau ti cc im truy nhp Internet
bng rng
Dch v thu knh ring c nh mt t
Dch v truyn dn tn hiu truyn hnh s
qua bng Ku ca v tinh VINASAT
69
10
11
Dch v tr gip tra cu s thu bao in

thoi c nh v Dch v vin thng bt
buc
Thit lp ng truyn dn cp quang kt
nt t t lin n trung tm hnh chnh
ca cc huyn o trn c s h tng cp
quang ca EVN
Dch v vin thng v tinh phc v hot
ng ch o, iu hnh phng, chng
thin tai
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
I DIN DOANH NGHIP

70
MU 05/DV Ph biu 03
Doanh nghip:
BNG K H NGHO, H CN NGHO C H TR CUNG CP DCH V IN THOI C NH MT T TR

SAU V DCH V THNG TIN DI NG MT T TR SAU
Thngnm
STT
A
1
2
M
huy
n
M
x
Tn
ch h
1
S
CMND
ca ch
h
M s
h
a
ch
4
Tn ch
thu bao
5
S in thoi
C nh
6
Di ng
7
S
hp
ng
S
ha
n
Cc
pht
sinh
Kinh
ph h
tr
(ng)
Ghi
ch
10
11
12
Ghi ch:
Doanh nghip vin thng ch bo co nhng thu bao c s dng dch v in thoi c nh mt t tr sau, dch v thng tin di
ng trong thng v gi bn mm v Ban Qun l Chng trnh.
Ct (9): Ghi s trn ha n c lp khi doanh nghip bn dch v cho khch hng.
Ct (10): Ghi gi tr cc pht sinh (cha bao gm thu VAT) do khch hng s dng dch v.
Ct (11): Ghi gi tr kinh ph doanh nghip ngh h tr.
71
MU 05/DV Ph biu 04
Doanh nghip:
Tnh:
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V IN THOI C NH MT T

TR SAU CHO H NGHO, H CN NGHO
Qunm
Sn lng
S
T
T
M
huyn
M x
Thng th Thng th
nht
hai
(thu bao) (thu bao)
1
Kinh ph
Thng th
ba
(thu bao)
3
Tng sn
lng
(lt thu
bao)
4=1+2+
3
Thng
th nht
(ng)
Thng
th hai
(ng)
Thng
th ba
(ng)
Tng kinh
ph h tr
(ng)
Ghi
ch
8=5+6+7
1
2
3
4
5
6
7
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Ghi ch:
Doanh nghip vin thng ch tng hp nhng thu bao c s dng dch v in thoi c nh mt t tr sau hoc dch v thng tin di
ng trong thng.
72
MU 05/DV Ph biu 05
Doanh nghip:
Tnh:
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V DCH V THNG TIN DI NG MT

T TR SAU CHO H NGHO, H CN NGHO
Qunm
Sn lng
Kinh ph
S
T
T
M
huyn
M
x
Thng
th nht
(thu
bao)
Thng
th hai
(thu
bao)
Thng
th ba
(thu
bao)
Tng sn
Thng th Thng th
lng
nht
hai
(lt thu
(ng)
(ng)
bao)
4=1+2+
5
6
3
Thng
th ba
(ng)
Tng kinh
ph h tr
(ng)
Ghi ch
8=5+6+7
1
2
3
4
5
6
7
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Ghi ch:
Doanh nghip vin thng ch tng hp nhng thu bao c s dng dch v in thoi c nh mt t tr sau hoc dch v thng tin di
ng trong thng.
73
MU 05/DV Ph biu 06
Doanh nghip:
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V IN THOI C NH MT T

TR SAU V DCH V THNG TIN DI NG MT T TR SAU CHO H NGHO, H CN NGHO
Qunm
ST
T
Tnh/Thnh
ph
A
1
2
3
4
5
6
7
Dch v in thoi c nh mt t tr sau

Tng s lt thu
Kinh ph h tr
bao c h tr
trong qu
trong qu (lt thu
(ng)
bao)
1
2
Dch v thng tin di ng mt t tr sau

Tng s lt thu
Kinh ph h tr
bao c h tr
trong qu
trong qu (lt thu
(ng)
bao)
3
4
Ghi ch
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON
TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
74
MU 05/DV Ph biu 07
Doanh nghip:
Tnh:
BNG K TRNG HC, BNH VIN, Y BAN NHN DN CP X C H TR CUNG CP DCH V TRUY NHP
INTERNET BNG RNG C NH TR SAU
Thngnm
STT
A
1
2
3
4
5
M
huyn
M x
Tn trng hc,
bnh vin, y
a ch lp t
ban nhn dn x
1
M
thu
bao
S hp
ng
Gi
cc
truy
nhp
5
S ha
n
6
Cc
truy
nhp
(ng)
7
Kinh ph
h tr
(ng)
Ghi ch
Ghi ch: Doanh nghip vin thng ch bo co nhng thu bao c s dng dch v trong thng v gi bn mm v Ban Qun l Chng trnh.
Doanh nghip:
MU 05/DV Ph biu 08
75
Tnh:

BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V TRUY NHP INTERNET
BNG RNG C NH TR SAU CHO TRNG HC, BNH VIN, Y BAN NHN DN CP X
Qunm
Sn lng
STT M huyn
M huyn
A
M x
Thng
th
nht
(thu
bao)
Thng
th hai
(thu
bao)
Thng
th ba
(thu
bao)
Tng s
(lt thu
bao)
Gi
cc
truy
nhp
4=1+2+3
Ghi ch
Kinh ph
Thng
th
nht
(ng)
Thng
th hai
(ng)
Thng
th ba
(ng)
Tng
kinh
ph h
tr
(ng)
9=6+7
+8
10
M x 1
Gi 4Mbps
Gi 12Mbps
Gi 32Mbps
Gi 45Mbps
M x 2
Cng
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
76
MU 05/DV Ph biu 09
Doanh nghip:

BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V TRUY NHP INTERNET BNG
RNG C NH TR SAU CHO TRNG HC, BNH VIN, Y BAN NHN DN CP X
Qunm
STT
Tnh/Thnh ph
A
1
Tng s lt thu bao

c h tr trong qu
(lt thu bao)
1
Gi cc truy nhp
Kinh ph h tr
(ng)
Ghi ch
Tnh A
Gi 4Mbps
Gi 12Mbps
Gi 32Mbps
Gi 45Mbps
Tnh B
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
77
MU 05/DV Ph biu 10
Doanh nghip:
Tnh:...
BNG K IM TRUY NHP INTERNET CNG CNG C H TR DUY TR

Thngnm
ST
T
M
huyn
M x
Tn im
truy
nhp
A
1
2
3
a ch lp
t
2
M thu
bao
S
hp
ng
Gi
cc
S ha
n
Cc
truy
nhp
(ng)
7
Kinh ph
h tr
(ng)
Ghi ch
Ghi ch: Doanh nghip vin thng ch bo co nhng im c cung cp dch v trong thng v gi bn mm v Ban Qun l Chng
trnh.
78
Doanh nghip:
MU 05/DV Ph biu 11
Tnh:

BO CO SN LNG V KINH PH H TR DUY TR IM TRUY NHP INTERNET CNG CNG
Qunm
Sn lng
STT
A
1
2
3
4
5
6
7
M
huyn
M x
Thng
th nht
(im)
Thng
th hai
(im)
Thng
th ba
(im)
Tng s
(lt
(im)
4=1+2+3
Thng
th
nht
(ng)
5
Kinh ph
Thng
Thng
th
th ba
hai
(ng)
(ng)
6
7
Ghi ch
Tng kinh
ph h tr
(ng)
8=5+6+7
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
79
MU 05/DV Ph biu 12
Doanh nghip:

BO CO SN LNG V KINH PH H TR DUY TR IM TRUY NHP INTERNET CNG CNG
Qunm
STT
Tnh/Thnh ph
Tng s lt im c h tr
(lt im)
Kinh ph h tr
(ng)
Ghi ch
A
1
2
3
4
5
6
7
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
80
Doanh nghip:
Tnh:
MU 05/DV Ph biu 13
BNG K KNH THU RING C NH MT T C H TR CA CC BNH VIN V TINH, BNH VIN HT

NHN
Thngnm
STT
A
1
2
3
4
5
6
7
M
huyn
M x
Tn bnh
vin
a ch
lp t
M
knh
S hp
ng
Tc
knh
S ha
n
Cc
thu
knh
7
Kinh ph
h tr
(ng)
8
Ghi ch
9
Ghi ch: Doanh nghip vin thng ch bo co nhng knh trong thng v gi bn mm v Ban Qun l Chng trnh.
Ct (7): Ghi gi tr cc thu knh (cha bao gm thu VAT) do khch hng s dng dch v.
81
MU 05/DV Ph biu 14
Doanh nghip:

BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V THU KNH RING C NH MT
T CA BNH VIN V TINH, BNH VIN HT NHN
Qunm
ST
T
A
1
2
3
4
5
6
7
Tnh/Thnh ph
B
Thng
th nht
(knh)
1
Sn lng
Thng
Thng
th hai
th ba
(knh)
(knh)
2
3
Tng s
(lt knh)
4
Thng
th nht
(ng)
5
Kinh ph
Thng
Thng
th hai
th ba
(ng)
(ng)
6
7
Tng s
(ng)
Ghi ch
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
82
MU 05/DV Ph biu 15
Doanh nghip:
BNG K KNH CHNG TRUYN DN TN HIU TRUYN HNH S S DNG BNG TN KU CA V TINH
VINASAT C H TR
Thng . . .nm.
STT
A
1
2
3
4
5
6
7
Tn i pht thanh
truyn hnh
a ch
S hp ng
S ha n
Cc thu
knh
(ng)
5
Kinh ph h
tr
(ng)
6
Ghi ch
7
Ghi ch: Doanh nghip vin thng ch bo co nhng knh chng trnh trong thng v gi bn mm v Ban Qun l Chng trnh.
Ct (5): Ghi gi tr cc thu knh (cha bao gm thu VAT) do khch hng s dng dch v.
83
MU 05/DV Ph biu 16
Doanh nghip:
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V TRUYN DN TN HIU TRUYN

HNH S PHC V TRUYN HNH S DNG BNG TN KU CA V TINH VINASAT
Qu . . .nm.
Sn lng
STT
A
1
2
3
4
5
6
7
Tnh/Thnh
ph
B
Thng
th
nht
(knh)
1
Kinh ph
Thng
th hai
(knh)
Thng
th ba
(knh)
Tng s
(lt knh)
Thng
th nht
(ng)
Thng
th hai
(ng)
Thng
th ba
(ng)
Tng s
(ng)
Ghi ch
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
84
MU 05/DV Ph biu 17
Doanh nghip:
Tnh:

BNG K THU BAO VIN THNG DI NG HNG HI
QUA H THNG I THNG TIN DUYN HI C H TR
Thng . . .nm
ST
T
Tn ch
thu bao
Bin
s tu
M
thu
bao
A
2
3
S
hp
ng
3
S
S giy
ha
chng
n,
nhn ng
chng
k tu c
t
4
5
Lu lng lin lc
(pht)
C nh
ni tnh
5
C nh
lin tnh
6
Di
ng
7
Kinh
Mc
ph
h tr
h tr
(ng)
(ng)
8
Ghi ch
Ghi ch: Doanh nghip vin thng ch bo co nhng thu bao c s dng dch v trong thng v gi bn mm v Ban Qun l Chng
trnh.
Ct (6): Ghi s lng pht lin lc do khch hng s dng dch v.
85
MU 05/DV Ph biu 18
Doanh nghip:
Tnh:
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VIN THNG DI NG HNG HI

Qunm
Sn lng
STT
Tnh/Thnh ph
A
1
Thng
th
nht
(pht)
1
Ghi ch
Kinh ph
Thng
th hai
(pht)
Thng
th ba
(pht)
Tng s
(pht)
Thng
th
nht
(ng)
5
Thng
th hai
(ng)
Thng
th ba
(ng)
Tng s
(ng)
Tnh A
C nh ni tnh
C nh lin tnh
Di ng
Tnh B
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
86
MU 05/DV Ph biu 19
Doanh nghip:

BNG K S KIN TM KIM, CU NN TRN BIN QUA H THNG I THNG TIN DUYN HI C H TR
Thngnm
STT
M s kin
S
kin/Phng
tin
A
1
2
3
4
Thi gian
bt u
Thi
gian kt
thc
Thi
lng
s kin
(gi)
5
Mc
h tr
(ng)
Kinh ph
h tr
(ng)
Ghi ch
Ghi ch: Doanh nghip vin thng ch bo co s kin trong thng v gi bn mm v Ban Qun l Chng trnh.
Ct (1): Ghi m h s s kin km theo.
Ct (2): Ghi bin s tu v tnh cht tai nn.
Ct (3), ct (4) Thi gian bt u v thi im kt thc s kin c tnh t thi im C quan ch tr tm kim, cu nn yu cu pht v
dng pht thng tin tm kim, cu nn v ngi, phng tin ang gp nguy him trn bin theo quy nh.
Ct (6): Mc h tr
87
MU 05/DV Ph biu 20
Doanh nghip:

BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VIN THNG DI NG HNG HI
QUA H THNG I THNG TIN DUYN HI PHC V HOT NG TM KIM, CU NN TRN BIN
Qunm
ST
T
A
1
Thng th
nht
(gi)
1
Sn lng
Thng th
Thng th
hai
ba
(gi)
(gi)
2
3
Tng s
(gi)
4
Thng th
nht
(ng)
5
Kinh ph
Thng th Thng th
hai
ba
(ng)
(ng)
6
7
Ghi ch
Tng s
(ng)
8
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
88
MU 05/DV Ph biu 21
Doanh nghip:
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VIN THNG KHN CP V H

TR TRA CU S IN THOI C NH
Qunm
ST
T
Tnh/Thnh
ph
Thng th
nht
(pht)
Thng th
hai
(pht)
Thng th
ba
(pht)
Tng s pht
lin lc trong
qu
Mc h
tr
Kinh ph
h tr
(ng)
Ghi ch
A
1
2
3
4
5
6
7
8
9
10
4=1+2+3
Tnh A
113
114
115
116
Tnh B
113
114
115
116
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
89
MU 05/DV Ph biu 22
Doanh nghip:
BO CO KINH PH THC HIN H TR CUNG CP DCH V VIN THNG V TINH PHC V HOT NG
CH O, IU HNH PHNG, CHNG THIN TAI
Qu . . .nm.
STT
Tn dch v
A
1
2
3
4
Thng
th
nht
(ng)
1
Lu lng pht sinh

Thng Thng
th hai
th
Tng cc s
ba
dng
(ng) (ng)
2
3
4=1+2+3
Kinh ph h tr
Thng Thng Thng
th
th hai th ba Tng kinh ph
nht
h tr
(ng) (ng) (ng)
5
6
7
8=5+6+7
Ghi ch
.., ngy.thng .. nm
NGI LP BIU
K TON TRNG
(K, ghi r h v tn)
(K, ghi r h v tn)
Ghi ch:
Ct (1), (2), (3) Ghi cc s dng cha bao gm thu VAT.
Ct (4): Ghi tng cc s dng cha bao gm thu VAT.
Ct (5), (6), (7) Ghi kinh ph h tr.
Ct (8): Ghi tng kinh ph h tr.
GIM C
(K tn, ng du)
90
MU 05/DV Ph biu 23
Doanh nghip:
BO CO SN LNG V KINH PH THC HIN H TR THIT LP NG TRUYN DN CP QUANG T T

LIN N TRUNG TM HNH CHNH CA CC HUYN O
Qu . . .nm.
Gi tr ha n
STT
Tn huyn o
A
1
2
3
4
5
Thng
th
nht
(ng)
1
Ghi ch
Kinh ph h tr
Thng
th hai
(ng)
Thng
th ba
(ng)
Tng gi tr
ha n
(ng)
4=1+2+3
Thng
th
nht
(ng)
5
Thng
th hai
(ng)
Thng
th ba
(ng)
Tng kinh
ph h tr
8=5+6+7
.., ngy.thng .. nm
NGI LP BIU
K TON TRNG
(K, ghi r h v tn)
(K, ghi r h v tn)
Ghi ch:
Ct (1), (2), (3) Ghi gi tr ha n cha bao gm thu VAT.
Ct (4): Ghi tng gi tr ha n cha bao gm thu VAT.
Ct (5), (6), (7) Ghi kinh ph h tr.
Ct (8): Ghi tng kinh ph h tr.
GIM C
(K tn, ng du)
91
Mu 06/DV - Bin bn nghim thu

Ph biu 01 - Bin bn
CNG HO X HI CH NGHA VIT NAM

.., ngy .thng. nm 200..
BIN BN NGHIM THU
SN LNG, KINH PH H TR DCH V VIN THNG CNG CH
Qunm
Doanh nghip:.
I. Thnh phn tham gia
1. i din Ban Qun l Chng trnh cung cp dch v vin thng cng ch
(bn A):
- ng (b): .. Chc v:
-
2. i din doanh nghip (bn B):
- ng (b): Chc v:
-
II. Ni dung nghim thu
1. Phm vi:
Nghim thu thc hin hp ng t hng cung ng dch v vin thng cng ch
s .../ /H/VTCI qu... nm ......(hoc nm ......) ca.......................
2. S liu nghim thu:
S liu nghim thu chi tit trong Ph lc km theo
3. Thuyt minh.
(Nu r nguyn nhn chnh lch gia s liu nghim thu ca Ban Qun l v s
liu bo co ca doanh nghip (nu c):
III. Nhn xt, kin ngh.

1. Nhn xt:
-
2. Kin ngh vi c quan cp trn.
3. Kt lun:
Bin bn ny c lp thnh bn, mi bn gi bn.
i din doanh nghip
(K, h tn, ng du)
i din Ban Qun l Chng

trnh
(K, h tn, ng du)
92
Doanh nghip:
(Ban
SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VI
Qu..nm ...
ST
T
A
1
2
3
4
Dch v
B
Dch v in thoi c nh mt t tr
sau
Dch v thng tin di ng mt t tr
sau
Sn liu ngh
nghim thu
Sn liu nghim thu
Sn lng
Kinh ph
Sn lng
Kinh ph
Dch v vin thng di ng hng hi

phc v hot ng tm kim cu nn
trn bin
nh tr sau cho trng hc, bnh vin,
y ban nhn dn x
Dch v duy tr im truy nhp Internet

bng rng
Dch v thu knh ring c nh mt t
Dch v truyn dn tn hiu truyn hnh

s qua bng Ku ca v tinh VINASAT
Dch v tr gip tra cu s thu bao

in thoi c nh v Dch v vin thng
bt buc
10
Thit lp ng truyn dn cp quang

kt nt t t lin n trung tm hnh
chnh ca cc huyn o trn c s h
tng cp quang ca EVN
11
Dch v vin thng v tinh phc v hot

ng ch o, iu hnh phng, chng
thin tai
93
I D
I DIN DOANH NGHIP

(K, ghi r h tn)
Doanh nghip:
SN LNG V KINH PH THC HIN H TR CUNG CP DCH V V

Dch v: . . . . . . . .
Qu . . . . . nm . . .
STT
A
1
2
3
4
5
6
7
Tnh/
Thnh ph
B
S liu ngh nghim thu
S liu nghim thu
Sn lng
Kinh ph
(ng)
Sn lng
)
Kinh ph
(ng)
94
Doanh nghip:
(B
Nm ...
ST
T
A
1
2
3
4
5
6
7
8
Dch v
B
Dch v in thoi c nh mt t tr
sau
Dch v thng tin di ng mt t tr
sau
Sn liu hp
ng t hng
Sn liu
ngh nghim
thu
Sn liu
nghim thu
Sn
lng
Kinh
ph
Sn
lng
Kinh
ph
Sn
lng
Kin
ph

phc v hot ng tm kim cu nn
trn bin
Dch v truy nhp Internet bng rng
c nh tr sau cho trng hc, bnh
vin, y ban nhn dn x
Dch v duy tr im truy nhp Internet
bng rng
Dch v thu knh ring c nh mt
t
Dch v truyn dn tn hiu truyn hnh
s qua bng Ku ca v tinh VINASAT
Dch v tr gip tra cu s thu bao

in thoi c nh v Dch v vin
thng bt buc
10
Thit lp ng truyn dn cp quang

kt nt t t lin n trung tm hnh
chnh ca cc huyn o trn c s h
tng cp quang ca EVN
11
Dch v vin thng v tinh phc v

hot ng ch o, iu hnh phng,
chng thin tai
95
I DIN DOANH NGHIP

(K, ghi r h tn)
I DIN
96
Doanh nghip:

Dch v: . . . . . . . .
Nm . . .
S liu ngh nghim thu
STT
A
1
2
3
4
5
6
7
Tnh/
Thnh ph
B
S liu nghim thu
Sn lng
(lt thu bao)
Kinh ph
(ng)
Sn lng
(lt thu bao)
Kinh ph
(ng)
97
Mu 07/DV Bin bn thanh l hp ng t hng cung ng dch v vin thng cng ch

Ph biu 01 - Bin bn
c lp- T do- Hnh phc
H ni, ngy
thng
nm 20. . .
BIN BN THANH L HP NG T HNG

CUNG NG DCH V VIN THNG CNG CH
S: /H/VTCI 20. . .
S:
/H/DVVTCI
- Cn c B Lut Dn s ngy 14 thng 6 nm 2005;

- Cn c Lut Vin thng ngy 23 thng 11 nm 2009;
- Cn c Ngh nh s 25/2011/N-CP ngy 06 thng 04 nm 2011ca
Chnh ph quy nh chi tit v hng dn thi hnh mt s iu ca Lut Vin
thng v vin thng;
- Cn c Quyt nh s 1168/Q-TTg ngy 24/7/2015 ca Th tng
nm 2020;
- Cn c Quyt nh s
/Q-BTTTT ngy thng nm ca B
trng B Thng tin v Truyn thng v vic ph duyt k hoch cung ng dch
v vin thng cng ch nm;
Hm nay, ngy
thng
nm 20 , ti H Ni chng ti gm:
BN A: Bn t hng cung ng dch v vin thng cng ch Ban

Qun l chng trnh cung cp dch v vin thng cng ch
i din
Chc v
ia ch
in thoi :
Fax
Ti khon
Ti
M s thu :
98
BN B: Bn nhn t hng cung ng dch v vin thng cng ch

i din
Chc v
a ch
in thoi :
Fax
Ti khon
Ti
M s thu :
Hai bn thng nht k kt Bin bn thanh l Hp ng t hng cung ng
dch v vin thng cng ch s: /H/VTCI ngy / / vi cc ni dung nh
sau:
I. H s ca Bin bn thanh l:
1. Bin bn thanh l v ph lc s liu chi tit.
2. Cc bin bn nghim thu sn lng, bin bn xc nh kinh ph cung
ng dch v vin thng cng ch:
- Bin bn nghim thu dch v vin thng cng ch nm
ngy
theo
Hp ng t hng s /H/VTCI
ngy gia Ban Qun l chng trnh
cung cp dch v vin thng cng ch vi . . . . . . . .. .. ;
II. Phm vi thanh l:
Thanh l phn sn lng v kinh ph thc hin cung ng dch v vin
thng cng ch thuc hp ng t hng s /H/VTCI
ngy cho .
III. Ni dung cc iu khon thanh l:
iu 1: Tnh hnh chung thc hin Hp ng t hng
iu 2: Kt qu thc hin Hp ng t hng
Tng kinh ph h tr doanh nghip c thanh ton trong nm
2.2. Bn B cung ng cc dch v vin thng cng ch cho cc i

tng c hng chnh sch h tr s dng dch v vin thng cng ch theo
quy nh ca Nh nc.
99
iu 3: Thanh ton kinh ph thc hin Hp ng

3.1. Tng gi tr Hp ng t hng s
/H/VTCI
ngy
3.2. Kinh ph c B Thng tin v Truyn thng ph duyt l:

3.3. Tng kinh ph h tr doanh nghip c thanh ton theo cc bin bn
nghim thu kinh ph h tr cung ng dch v vin thng cng ch trong l:
3.4. Tng s kinh ph tm ng cho doanh nghip cung cp dch v vin
thng cng ch nm:
* Tm cp t 1:
ng ngy
* Tm cp t 2: ng ngy :
3.5. Kinh ph doanh nghip cn c thanh ton (hoc thu hi) = Kinh ph
c thanh ton (3.3) Kinh ph tm ng (3.4)
iu 4: Bn A c ngha v thanh ton cho bn B phn kinh ph nh ghi
ti khon 3.5 iu 3 bin bn ny trong phm vi 01 thng, k t ngy hai bn
hon thnh th tc thanh l Hp ng t hng s /H/VTCI ngy (theo
quy nh ti khon 6 iu 8 Hp ng t hng s: /H/VTCI ngy
iu 5: Sau khi c B Thng tin v Truyn thng ph duyt quyt ton
nm , bn A s thng bo kt qu ph duyt quyt ton s kinh ph h cung ng
dch v vin thng cng ch nm
cho bn B.
iu 6: Ban Qun l chng trnh vin thng cng ch v thng nht
c thanh l v kt thc Hp ng t hng s /H/VTCI ngy
.
Bin bn ny gm 06 iu, trang c nh s lin tc t trang 01 n
trang v
ph lc i km. Bin bn ny c lp thnh 06 bn, c gi tr
php l nh nhau. Mi bn gi 03 bn./.
I DIN BN A
I DIN BN B
100
Mu 01/THS n ngh h tr u thu truyn hnh s

N NGH H TR U THU TRUYN HNH S
Knh gi: S Thng tin v Truyn thng Tnh (Thnh ph).........
Ti tn l: .
S CMND ca ch h ni cp cp ngy
in thoi:..
Ch hin ti:..
M s h ngho, cn ngho:
L ch h gia nh thuc din:
H ngho
H cn ngho
theo tiu chun ngho, cn ngho quy nh ti Quyt nh s 59/2015/QTTg ca Th tng Chnh ph ngy 19/11/2015 v vic ban hnh chun ngho
tip cn a chiu p dng cho giai on 2016 - 2020.
Hin nay, gia nh ti ang s dng my thu hnh cng ngh tng t cha
tch hp tnh nng thu truyn hnh s theo chun DVB-T2, cha c u thu
truyn hnh s DVB-T2, cha s dng bt k mt trong cc phng thc truyn
hnh tr tin nh truyn hnh cp, truyn hnh v tinh, truyn hnh IPTV.
Ti lm n ny ngh c h tr u thu truyn hnh s s dng cho
gia nh v cam kt khng bn, cho, tng u thu c h tr. Ti xin cam oan
cc thng tin nu trn l ng s tht, nu sai ti xin chu hon ton trch nhim
trc php lut.
Trn trng cm n./.
., ngythngnm
XC NHN CA TRNG THN/PH
(K v ghi r h tn)
NGI LM N
(K v ghi r h
tn)
XC NHN CA UBND X, PHNG

101
Ghi ch: Ch hin ti ghi r thn, x, huyn, tnh (Thnh ph)

Mu 02/THS
Danh sch tng hp i tng c h tr u thu truyn hnh s
UBND TNH, THNH PH
BNG TNG HP I TNG IU KIN C HNG H
TR U THU TRUYN HNH S
(Ban hnh km theo Thng t s /2016/TT-BTTTT ngy thng nm 2016

ca B trng B Thng tin v Truyn thng)
TT
i tng h tr
Tng
Ghi ch
H ngho
H cn ngho
Tng
.., ngy
NGI LP BIU
TM. Y
(K, ghi r h v tn)
(K, g
102
Mu 03/THS
Danh sch h ngho c hng h tr u thu truyn hnh s
UBND TNH, THNH PH
DANH SCH H NGHO IU KIN C HNG H TR
U THU TRUYN HNH S TRN A BN TNH, THNH PH
(Ban hnh km theo Thng t s /2016/TT-BTTTT ngy thng nm 2016

ca B trng B Thng tin v Truyn thng)
STT
Qun/
Huyn
X/phn
g
Tn ch h
M s h
ngho
S CMND
ca ch h
in thoi
a ch
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
CH TCH
Cch lp biu:
Ct (B), ct (C): Ghi tn huyn, x
Ct (2): Ghi m s h ngho.
103
Ct (3): Ghi s CMND ca ch h.

Ct (4): Ghi s in thoi ca h (nu c).
Ct (5): Ghi a ch ca h: s nh, thn/bn/khi ph.
104
Mu 04/THS Danh sch h cn ngho c h tr u thu truyn hnh s

UBND TNH, THNH PH
DANH SCH H CN NGHO IU KIN C HNG H TR
U THU TRUYN HNH S TRN A BN TNH, THNH PH
(Ban hnh km theo Thng t s /2016/TT-BTTTT ngy thng nm 2016 ca

STT
Qun/
Huyn
X/phn
g
Tn ch
h
M s h
cn ngho
2
S CMND
ca ch h
in thoi
a ch
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
CH TCH
Cch lp biu:
Ct (B), ct (C): Ghi tn huyn, x
Ct (2): Ghi m s h cn ngho.
Ct (3): Ghi s CMND ca ch h.
105
Ct (4): Ghi s in thoi ca h (nu c).

Ct (5): Ghi a ch ca h: s nh, thn/bn/khi ph
106
Mu 05/THS K hoch v d ton kinh ph h tr

UBND TNH, THNH PH
K HOCH V D TON KINH PH H TR U THU TRUYN HNH S

Tnh, Thnh ph: .
(Ban hnh km theo Thng t s /2016/TT-BTTTT ngy
thng nm 2016 ca B trng B Thng tin v Truyn thng)
S lng (u thu)
ST
T
Tnh, Thnh
ph/Huyn/x
Qun (Huyn).
1.1
H ngho H cn ngho
1
Kinh ph h tr (triu ng)

Tng
H ngho
H cn ngho
Tng
Thi gian
thc hin
Ghi ch
107
1.2
2
X
Qun (Huyn).
2.1
2.2
Cng
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
TH TRNG N V
108
Mu 06/THS Bng k chi tit i tng nhn h tr u thu truyn hnh s

CH U T: .
BNG K CHI TIT I TNG NHN H TR U THU TRUYN HNH S
Tnh, Thnh ph: .

STT
Qun/Huyn
X/phng Tn ch h
M s h S CMND ca
ngho,
ch h
cn ngho
2

S
a ch
in thoi
4
i tng c h tr
S thit b
Ngy bn
H ngho H cn ngho
(Seri number)
giao/ lp t
1
2
3
Tng s h c h tr: . h
Tng kinh ph h tr: .. ng
.., ngy.thng .. nm
XC NHN CA
NGI LP BIU
I DIN NH THU
UBND TNH, THNH PH
(K, ghi r h v tn)
109
Ghi ch:
+ Ct 5 - a ch: ghi r s nh, thn/bn/khi ph
110
Mu 07/THS - Bo co s lng v kinh ph h tr u thu truyn hnh s
CH U T: .
BO CO S LNG V KINH PH H TR U THU TRUYN HNH S

Tnh, Thnh ph: .
ST
T
Tnh, Thnh
ph/Huyn/x
Qun (Huyn).
S lng (u thu)
Kinh ph h tr (triu ng)

Ghi ch
H ngho
H cn ngho
Tng
H ngho
H cn ngho
Tng
111
1.1
1.2
Qun (Huyn).
2.1
2.2
Cng
.., ngy.thng .. nm
NGI LP BIU
TH TRNGN V
112
(K, ghi r h v tn)
113
Mu 01/BC
B THNG TIN V TRUYN THNG
QU DCH V VIN THNG

CNG CH VIT NAM
-------------
c lp T do Hnh phc
------------------------------------
S:
/BCNV
, ngy thng
BO CO NGUN VN HOT NG CA QU DCH V
VIN THNG CNG CH VIT NAM
nm .
(Qu/6thng/nm)
n v tnh: Triu ng
ST
T
Ni dung
Lu k
s tin
Qu
thu c
t u
chng
trnh n
u k
bo co
1
Doanh
nghip a
Doanh
nghip b
S tin ng gp ca
doanh nghip trong k
K
hoch
Thc
hin
So snh
(%)
4=(3)/(2)
Lu k s
tin Qu
thu
c t
u
chng
trnh n
cui k
bo co
Ghi
ch
5=(1)+(3)
Tng s
TH TRNG N V
(K tn, ng du)
Ghi ch
- Qu s dng mu bo co ny bo co ngun vn hot ng ca Qu.
114
- Qu gi Ban Qun l Chng trnh cc bo co qu I, qu III trc ngy 10 ca

thng u qu tip theo, bo co 6 thng trc ngy 10 thng 7 ca nm bo co,
bo co nm trc ngy 10 thng 02 nm sau.
115
Mu 02A/BC
BAN QUN L CHNG TRNH CUNG CP DCH
V VIN THNG CNG CH
-------------------S:

c lp T do Hnh phc
------------------------------------
/BCSDKP
, ngy
thng
nm .
BO CO TNH HNH S DNG KINH PH CA CHNG TRNH

(Qu/6thng/nm)
n v tnh: Triu ng
M s
Ni dung
(Theo cc nhim v ti
Quyt nh 1168/Q-TTg)
Tng s kinh ph
Tng s kinh ph
h tr doanh
nghip t u
chng trnh
n u k bo
co
K
hoch
c
duyt
trong
nm
S tin h tr
trong k
Thc
hin
trong k
Lu k
..
..
So snh
(%)
Lu k t u
chng trnh
n cui k bo
co
Ghi
ch
5=(4)/(2)
6=(1)+(3)
t u
nm
..
TH TRNG N V
(k tn, ng du)
Ghi ch
- Ban Qun l Chng trnh s dng mu ny bo co tnh hnh s dng kinh ph Chng trnh.
- Ban Qun l Chng trnh gi B Thng tin v Truyn thng cc bo co qu I, qu III trc ngy 10 ca thng u
qu tip theo, bo co 6 thng trc ngy 10 thng 7 ca nm bo co, bo co nm trc ngy 10 thng 02 nm sau.
116
Mu 02B/BC
BAN QUN L CHNG TRNH CUNG CP DCH
V VIN THNG CNG CH
-------------------S:

c lp T do Hnh phc
------------------------------------
/BCSL
, ngy
thng
nm .
So snh
(%)
Lu k t
u
chng
trnh n
cui k
bo co
Ghi ch
5=(4)/(2)
6=(1)+(3)
BO CO SN LNG C H TR CA CHNG TRNH

(Qu/6thng/nm)
M
s
Ni dung
(Theo cc nhim v ti
Quyt nh 1168/Q-TTg)
n v
Tng s sn
lng h tr
doanh nghip t
u chng
trnh n u k
bo co
K
hoch
c
duyt
trong
nm
Sn lng h tr
trong k
Thc
hin
trong k
Lu k
..
..
t u
nm
..
TH TRNG N V
(k tn, ng du)
Ghi ch
- Ban Qun l Chng trnh s dng mu ny bo co sn lng dch v vin thng cng ch c h tr ca Chng
trnh.
- Ban Qun l Chng trnh gi B Thng tin v Truyn thng cc bo co qu I, qu III trc ngy 10 ca thng u
qu tip theo, bo co 6 thng trc ngy 10 thng 7 ca nm bo co, bo co nm trc ngy 10 thng 02 nm sau.
117
Mu 03A/BC
DOANH NGHIP VIN THNG
-------------------S:

c lp T do Hnh phc
------------------------------------
/BCSDKP
, ngy
thng
nm .
BO CO TNH HNH S DNG KINH PH CA CHNG TRNH

(Qu/6thng/nm)
n v tnh: Triu ng
M s
Ni dung
(Theo cc nhim v ti Quyt

nh 1168/Q-TTg)
Tng s kinh ph
Tng s kinh ph
h tr doanh
nghip t u
chng trnh n
u k bo co
K hoch
c
duyt
trong
nm
S tin h tr trong
k
Thc
hin
trong k
Lu k
..
..
So snh
(%)
Lu k t
u chng
trnh n
cui k bo
co
Ghi
ch
5=(4)/(2)
6=(1)+(3)
t u
nm
..
TH TRNG N V
(k tn, ng du)
Ghi ch
- Doanh nghip vin thng s dng mu ny bo co Ban Qun l Chng trnh tnh hnh s dng kinh ph Chng
trnh.
118
- Doanh nghip vin thng gi Ban Qun l Chng trnh cc bo co qu I, qu III trc ngy 10 ca thng u qu
tip theo, bo co 6 thng trc ngy 10 thng 7 ca nm bo co, bo co nm trc ngy 10 thng 02 nm sau.
119
Mu 03B/BC
DOANH NGHIP VIN THNG
-------------------S:

c lp T do Hnh phc
------------------------------------
/BCSL
, ngy
thng
nm .
BO CO SN LNG C H TR CA CHNG TRNH

(Qu/6thng/nm)
M
s
Ni dung
(Theo cc nhim v ti Quyt

nh 1168/Q-TTg)
n v
Tng s sn lng
h tr doanh
nghip t u
chng trnh n
u k bo co
K hoch
c
duyt
trong
nm
Sn lng h tr
trong k
Thc
hin
trong k
Lu k
So snh
(%)
Lu k t
u
chng
trnh n
cui k
bo co
Ghi
ch
5=(4)/(2)
6=(1)+(3)
t u
nm
TH TRNG N V
(k tn, ng du)
Ghi ch
- Doanh nghip vin thng s dng mu ny bo co Ban Qun l Chng trnh sn lng dch v vin thng cng ch
c h tr ca Chng trnh.
120
- Doanh nghip vin thng gi Ban Qun l Chng trnh cc bo co qu I, qu III trc ngy 10 ca thng u qu
tip theo, bo co 6 thng trc ngy 10 thng 7 ca nm bo co, bo co nm trc ngy 10 thng 02 nm sau.
121

BTTTT 08 2016 TT BTTTT 30032016

Uploaded by

Copyright:

Available Formats

You might also like

BTTTT 08 2016 TT BTTTT 30032016

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

BTTTT 08 2016 TT BTTTT 30032016

Uploaded by

Copyright:

Available Formats

B THNGTIN V TRUYN THNG

CNG HA X HI CH NGHA VIT NAM

2. i tng c th hng ca Chng trnh.

a) Ph hp vi cc quy hoch, k hoch pht trin ca ngnh, a phng,

theo Mu 03/HT Ph lc ban hnh km theo Thng t ny.

b) Dch v vin thng cng ch di ng hng hi phc v hot ng tm

2. i tng th hng quy nh ti cc im a, b, c, d Khon 1 iu 9

chng trnh truyn hnh.

ng) theo Mu 04/DV Ph lc ban hnh km theo Thng t ny.

3. Phng thc v ni dung h tr

2. n v c la chn, giao thc hin nhim v thc hin theo quy nh

bo co Th tng Chnh ph v cc B, Ngnh lin quan.

Mu 03/HT ng k tham gia la

Mu 05/DV Bo co sn lng, Doanh nghip

Mu 01/DV n ng k thu bao

Mu 03/THS Danh sch h ngho

19 Mu 02A/BC Bo co tnh hnh s Ban

20 Mu 02B/BC Bo co sn lng Ban

21 Mu 03A/BC Bo co tnh hnh s Doanh nghip

22 Mu 03B/BC Bo co sn lng Doanh nghip

D kin thi gian

S dng trong trng hp lp Danh mc v s b Tng mc u t cc d

S dng trong trng hp lp Danh mc v s b Tng mc u t cc d

Kinh ph d kin l kinh ph xut h tr t ngun kinh ph Chng trnh.

Mi d n trong Ph biu 02 tng ng vi mt d n lit k ti Ph biu 01.

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.

Mu 01/HT/Ph biu 03/bng 1

Cc nhim v cn thc hin ti

Thit lp Thit lp Thit lp

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01;

Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3 iu

Ct (4) ny ng vi mi x ti ct (3), nu x l x ng bng, in k t x,

Ct (5) ny in k t x nu x c tn ti ct (3) c nhim v thit lp h thng

Ct (6) ny in k t x nu x c tn ti ct (3) c nhim v thit lp mng truy

Ct (7) ny in k t x nu x c tn ti ct (3) c nhim v thit lp mng truy

M tnh/thnh ph, huyn, x c quy nh ti Quyt nh s 124/2004/Q-TTg

Mu 01/HT/Ph biu 03/bng 2

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.

Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3

im kt ni cn thit lp l im m ti v tr c d tnh t tp trung

im kt ni sn c l im kt cui ca h thng truyn dn bng rng ang

Mu 01/HT/Ph biu 03/bng 3

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.

Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3

Mi tn im kt ni u hoc cui tng ng vi mt tn im kt ni cn

in ct (5) vi cc gi tr quang hoc viba hoc hn hp.

Mu 01/HT/Ph biu 03/bng 4

Tn mng truy nhp c

Mng truy nhp c nh x

[Tng chiu di mng

Mng truy nhp c nh x

[Tng chiu di mng

Mng truy nhp c nh x

[Tng chiu di mng

Tng chiu di cc tuyn

Tng chiu di cc tuyn

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.

Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3

H ni, ngy _thng _ nm ____